Carpal tunnel syndrome and pregnancy
• Carpal tunnel syndrome is a condition that occurs as a result of swelling around the nerves of the wrist.
• It can cause numbness, tingling or pain in one or both wrists.
• Pregnant women are particularly prone to the disorder, with about three to five of every 10 women experiencing symptoms during pregnancy.
• The carpal tunnel is a corridor that contains tendons and a nerve (the median nerve), that run through the base of your hand. It can swell and press against this sensitive nerve, causing pain.
While pregnancy is one cause, other common causes include arthritis or repetitive hand movements, which can occur among professionals such as musicians, office workers and manual labourers.
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• Most pregnant women feel the pain and numbness in the last trimester of pregnancy, although symptoms can occur as early as the first trimester.
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When you are pregnant, your hormone levels trigger fluid retention, which can cause swelling.
This swelling can, in turn, push against the median nerve in the carpal tunnel, increasing pressure and sometimes causing pain in your wrist and hand. • The condition is more common in the third trimester, but it can also happen in the first two trimesters or after the birth. In most cases, symptoms will pass after your baby is born.
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• Common signs and symptoms include:
• Pain - especially in the wrist, thumb, index finger or middle finger. Pain may worsen when you move your hand or if the weather is particularly hot. It’s also more likely to occur at night. Numbness - especially in the thumb, index finger or middle finger. A particularly bad case can result in difficulty holding on to or picking things up, and you may feel clumsy.
• Tingling - especially in the thumb, index finger or middle finger. Tingling may worsen when you move your hand or if the weather is particularly hot. It’s also more likely to occur at night. Weakness - stress on the nerve in the carpal tunnel can cause weakness in the thumb, index finger or palm of your hand. The intensity of symptoms can vary from mild irritation, to occasional soreness and serious pain. Symptoms may stop you from sleeping or make it difficult to perform regular tasks such as working, getting dressed, cooking or caring for your baby.
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• Repeating the same hand movements frequently.
•Keeping your hands in the same position for an extended time.
•Putting weight on straightened arms
•Swelling is a symptom of high blood pressure in pregnancy. If your hands or feet are more swollen than usual, speak to your doctor.
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•Almost all women experience swelling that may cause symptoms in the last trimester of pregnancy. It’s unfortunately one of those symptoms you can’t do much about, so try to soldier on through until delivery.
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The more you can do now to mitigate the effects of carpal tunnel syndrome, the more likely you will feel symptom-free after delivery. Here are some remedies: Try a wrist brace. If your carpal tunnel is causing you a lot of pain, ask your practitioner to recommend a wrist brace (you may be able to find one at your local pharmacy). Then make sure you wear it all day and at night. One study found that 80 % of pregnant women with carpal tunnel syndrome found relief by using one.
Stretch. If you work at a computer or do any other activity that requires repetitive motions, such as playing the piano or filing, take frequent hand-stretching breaks to relieve pain and tingling.
Get into position. If you spend a lot of time at a computer typing, type gently and make sure your wrists are straight and your elbows are higher than your hands. You may also want to look into buying an ergonomic keyboard designed to protect your hands and fingers.
Sleep freely. Don’t constrict your limbs at night. Try not to sleep on your hands, and use a pillow to prop up your arms at night. • Get the blood flowing. Shake your hands and wrists out frequently. At night, hang your hand over the side of the bed and shake it.
Limit salt intake. Reducing your sodium and salt intake can decrease swelling and water retention, both of which exacerbate carpal tunnel syndrome.
Ask about medication. Ask your doctor whether the non-steroidal antiinflammatory medications or steroids typically prescribed for carpal tunnel syndrome are safe to take during pregnancy.
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There are safe and effective treatments. Your choice of treatment will depend on several factors, including the severity of your symptoms and the stage of your pregnancy. Talk to your doctor if you think you may have carpal tunnel syndrome.
Some pregnant women find that pain is reduced by simple measures, such as: Elevating your hands when you’re resting or not using them.
Keeping your wrists in a neutral position (not bent forwards or backwards) during the day, and as much as possible while you’re sleeping.
Maintaining good posture in your arms and wrists while working at a desk. Taking breaks every 20 minutes while working at a desk.
Avoiding activities that strain your wrist You can also reduce the swelling by applying an ice pack on your inner wrist - or by placing your hand in cold water for between 30 seconds and 2 minutes. If your symptoms worsen, do not repeat. Treatment options include physiotherapy or occupational therapy. This may involve fitting you with a brace or splint to keep your wrist in the best position to reduce strain.
These splints must be adjusted to your specific wrist to be protective and supportive. Your therapist will be able to tell you how best to protect your wrist at home, including exercises and resting positions.
Your doctor may recommend steroids to reduce the amount of fluid retained in your body, or in certain circumstances may offer you a steroid injection to reduce swelling.
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• Carpal tunnel syndrome tends to ease, and often disappears, after birth.
If you still have pain after your baby is born, you may need to change the way you use your wrist. This might impact on how you use your hand to hold and care for your baby, including
how you feed your infant.
• Speak to your physiotherapist, occupational therapist or lactation consultant for strategies and tips on how to minimise strain on your wrist while holding your newborn.
Try to use a pram where possible to give your arm a chance to rest. It is also important to continue using your brace or splint if you have one.
While carpal tunnel syndrome is common during pregnancy, 19 out of 20 women will recover within the first 6 weeks after the baby is born.
If your symptoms persist after your baby is six weeks old, speak to your doctor.