Carpal Tunnel Syndrome During Pregnancy

When you think about the parts of a woman’s body that are affected by pregnancy, the hands and wrists are not the first thing that come to mind, but up to 20% of women are affected by carpal tunnel syndrome during pregnancy. Symptoms of carpal tunnel syndrome include numbness, tingling, burning or aching in the fingers, and pain in the wrist, hands, forearms, and sometimes upper arm to the shoulder. In severe or chronic cases, hands may feel weak or uncoordinated and muscle atrophy may be present. Symptoms usually affect both hands and can begin at any stage of pregnancy, but are most common in the later stages.

What is the carpal tunnel and what causes carpal tunnel syndrome during pregnancy?
The carpal tunnel is a canal at the base of the palm formed by the bones of the wrist (carpal bones) on three sides and a ligament (the transverse carpal ligament) that runs across the other. The flexor tendons and the median nerve run through this tunnel. When there is compression of the carpal tunnel, the median nerve can be pinched causing numbness and tingling and pain at the thumb, index finger, middle finger, and half of the ring finger and weakness in the thumb. During pregnancy, changes in hormone levels (progesterone) and fluid retention can place increased pressure in the tunnel causing symptoms.

Treatment Options
Treatment options for carpal tunnel syndrome include splinting or bracing, steroid injections, activity modification, physical or occupational/hand therapy, massage, medications, and surgery.  Medications and steroid injections are not utilized during pregnancy but may be beneficial after pregnancy if symptoms persist. Conservative treatment is recommended during pregnancy as many cases of carpal tunnel resolve after delivery as the hormone levels shift and the excess fluid is expelled from the body. If symptoms do persist, be sure to mention it to your doctor who may suggest use of anti-inflammatory medication or refer you to a specialist for further evaluation.

What can you do to relieve the symptoms?
In the meantime, there are things that you can do to decrease the symptoms:

• Avoid activities that require repetitive or forceful hand movements.
• Make workstation modifications to ensure that your wrists are not tilted downward (flexed) as you type.  This can include changing the height of your chair or using an ergonomic keyboard or keyboard pad.
• Change your sleeping position so that your wrists are not bent during sleep.
• Use a brace to keep the wrist in a neutral position to maximize the space in the carpal tunnel.
• Change or avoid activities that cause symptoms, and take frequent rest breaks during repetitive activities.
• Stretch forearm muscles regularly throughout the day.

If you are pregnant and experiencing the symptoms above, discuss with your doctor to receive an appropriate referral to physical therapy or occupational/hand therapy to assist you in managing your symptoms.