Carpal Tunnel Syndrome during Pregnancy

What is the carpal tunnel syndrome

The tingling sensation often felt in the hands and fingers by pregnant women is known as the carpal tunnel syndrome ^[1]. It may affect anyone and may occur due to various reasons, with a high incidence rate during pregnancy ^[2].

What causes carpal tunnel in pregnancy

Carpal tunnel refers to the narrow passage in the wrist through which the median nerve passes to the hand from the forearm along with several more tendons. The median nerve is responsible for supplying feeling to most of the fingers (thumb, index, middle fingers and part of ring finger) as well as for several thumb movements ^[3].

The fluid retention due to the increased blood volume and normal hormonal changes during pregnancy further constricts the already small tunnel created by the carpal (wrist) bones and the transverse carpal ligament ^{[4, 5]}. The additional pressure on the median nerve and ligaments leads to the tingling sensation in the fingers, characteristic of the carpal tunnel syndrome ^[6].

Risk factors

Being overweight from before pregnancy
Carrying twins
Having a family history of CTS
Having suffered from the symptoms in a previous pregnancy
History of a wrist injury or surgery ^[7]

Pregnancy induced carpal tunnel symptoms: What does it feel like

Apart from the pins and needles sensation, most women experience numbness or weakness in the fingers of one or both hands that may make it difficult to move them and carry out normal daily activities. It may sometimes cause mild to considerable pain in the fingers or the arm, even leading to temporary disability of the affected hand (rare) ^[3].

It may make it difficult for you to move the thumb or have a tight grip, leaving you clumsy and uncoordinated ^[8].

Your baby is safe within your uterus, with no threats of any harm from a CTS ^[11].

When do the symptoms occur

CTS is more common in the later second trimester and the third trimester ^[7], but may occur earlier in pregnancy as well.

The symptoms often worsen at night or early in the morning ^[6]. It is because the fluid that accumulates in your lower body during the day is distributed throughout the other parts of your body when you lie down at night, increasing the pressure on the hands and wrists ^[9].

How long does the carpal tunnel syndrome last

Being a temporary condition, it does not cause any permanent damage to the wrist or fingers. In most cases, it goes away within 2-3 months of delivery, as the hormone levels and the blood volume settle down gradually, while the edema subsides ^[2]. However, some women may continue to experience the symptoms for over year after pregnancy ^[10], especially if they are breastfeeding their babies ^[6].

How to treat and manage carpal tunnel symptoms in pregnancy

There is no treatment option that can completely cure the problem as it occurs due to normal body changes during these nine months. But, here are a few things you can try to relieve the symptoms to some extent:

Over-the-counter wrist braces or splinters can reduce the pain and numbness by reducing some pressure on the nerves and tendons, as it keeps the area immobilized, especially when you sleep at night ^[11].

Hot and cold therapy is another way to relieve the discomfort. Fill one bowl with some hot water and another with ice water. Then dip your hands in the first bowl for 30 seconds, followed by the second bowl for the same amount of time. Make sure the bowls are deep gh to keep the wrists well-immersed in the water.
Gently massaging the insides of the wrist joint, as well as the sides of the forearms may help relieve the pain. You may simply use the thumb of the other hand for the purpose or simply ask another person to help you ^[12].
Your doctor may recommend painkillers like paracetamol in case of a severe carpal tunnel as anti-inflammatories are not recommended during this time.

Cortisone shots, a common treatment option, are never recommended in pregnant and breastfeeding women ^[13].

Tips for relief

Rest your hands whenever possible.
Try to use the forearm and elbow joints instead of the wrists for moving the hands during activities like brushing your teeth, combing your hair and picking something up ^[12].
If you are experiencing more pain in one hand than the other, try to avoid sleeping on the affected side to avoid putting too much pressure on that hand. You also need to keep in mind the recommended sleeping postures for pregnancy ^[14].
When you are lying down, keep the forearms elevated using a pillow or rolled towel to prevent too much fluid from accumulating in the wrists ^[15].

Exercise

Here are a few strengthening and mobility exercises for the hands to try at home, but stop doing any exercise that seems to worsen the symptoms.

Stretch out your fingers as far as you can and hold them in that position for a few seconds before relaxing ^[12].
Close the fingers in a tight fist (don’t put too much pressure if it is painful) and then straighten them out.
Slowly move your arm from up to down, then from one side another and finally in a circular manner. Repeat each move 5 times.
Stretch out your fingers, then touch the thumb with the tip of each finger once, forming an ‘O’ shape every time ^[15].
Curl all fingers into a firm fist, bend the wrist inwards (toward your palm) then straighten the fingers and finally stretch the wrist outwards. Repeat 10 times a few times a day ^[16].

You may consider talking to a certified physician to find out if physiotherapy could help with the symptoms.

Alternative remedies to relieve the pain

Acupuncture is another alternative treatment option with a study suggesting it to be more effective in reducing the feeling of weakness than using splinters at night ^[7]. You may also try acupressure at home. (Acupuncture and acupressure during pregnancy)
Essential oils like lemon and cypress can help to reduce swelling in severe cases. Put a few drops of the oils in a bowl of warm water, soak a cloth in the mixture and wrap it around the affected wrist. You may also massage a little oil on the wrist the fingers for relief ^{[7, 17]}.

Treating carpal tunnel syndrome after pregnancy

NSAIDs can be used for treating any persisting symptoms post-pregnancy ^[1].

Surgical management is another option involving releasing the pressure on the median nerve through an incision made in the wrist ^[18]. Although surgery is not a recommended treatment option for pregnant women due to risks of infection and complications ^[3], it may be opted for in postpartum women in severe cases.

Can you prevent carpal tunnel during pregnancy

There is usually no way to prevent the problem in pregnant women. However, as repetitive movement of the fingers, like using the computer, typewriter, or playing a piano, increases the chances of developing the CTS, resting your fingers in between such activities may help ^[11].

Ensure healthy weight gain by following a well-balanced diet consisting of fresh fruits, green vegetables (avocado, broccoli), white, oily fish, and lean meat. These foods are also excellent sources of vitamin B6 that helps in keeping the nervous system healthy ^[7]. Having plenty of calcium and magnesium rich foods is also beneficial for maintaining the bones and nerves.

How common is carpal tunnel syndrome during pregnancy

Around 50% to 60% women report of experiencing the numb, tingling sensations at some stage of their pregnancy ^[19].

Carpal tunnel syndrome ICD-9 and ICD-10 codes

The ICD-9-CM code used for referring to the condition is 354.0 ^[20], while its ICD-10 code is G56.0 ^[21].

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