Carpal Tunnel Syndrome in Pregnancy

Introduction:

Compression of the median nerve causes carpal tunnel syndrome. The median nerve is a nerve of the upper limb that runs through the forearm into a narrow tunnel commonly known as the carpal tunnel, located between the muscles in the wrist region ending in the hands. This median nerve is usually responsible for sensations ( sensory function) and movements (motor) to the wrist, hands, and forearm. Therefore, nerve compression leads to symptoms like pain, burning sensation, numbness, and weakening of the hand, wrist, and forearm.

What Causes Carpal Tunnel Syndrome During Pregnancy?

During pregnancy, primarily around 30 weeks, due to the changes in the level of hormones, there is weight gain and fluid buildup in pregnant women leading to edema in the leg and other parts of the body. Most women start experiencing carpal tunnel syndrome symptoms during this period. Swelling or edema is a reason for the onset of the syndrome. In addition, pregnant women with a history of gestational diabetes mellitus and pregnancy-induced hypertension are also prone to carpal tunnel syndrome. Most pregnant women in their third trimester may also experience impairment in the function of their median nerve.

What Symptoms Are Most Seen in Carpal Tunnel Syndrome?

Some of the symptoms seen in this condition are

• The sensation of tingling and numbness in the hands, including fingers supplied by the median nerve (the thumb, index finger, middle finger, and ring finger half).

• Wrist pain is associated with a burning sensation that may spread to the shoulder or arm.

• Experiencing sensations like an electric shock in the fingers might.

• Proximal radiation, while not as common, is also unusual along the medial arm, volar forearm, and shoulder.

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• Placing the affected hands or wrists in positions causes compression at night, leading to numbness in the region while waking up.

• Exerting pressure or performing tough tasks using the affected hands for a longer duration may aggravate the symptoms.

• In severe cases or when the symptoms are aggravated, loss of grip might be experienced, causing difficulties in performing any tasks.

• The intensity of these symptoms can vary from soreness and mild irritation to excruciating pain and loss of strength.

• During the onset of carpal tunnel syndrome, the symptoms may be periodic, but when weakness or numbness occurs frequently, it is a sign of nerve damage.

How Is Carpal Tunnel Syndrome Diagnosed in Pregnant Women?

The doctor will take a detailed history and conduct a physical examination to diagnose the condition. These tests described below are completely safe for pregnant women.

1. Tinel's Sign Test - This test is a part of the physical examination. The doctor gently taps the skin over the affected area. In case of any nerve irritation or damage, the person will experience a tingling sensation in the area.

2. Electrodiagnostic Tests - In case of severe symptoms, electrodiagnostic tests are performed. This test detects the severity of nerve damage and its reversibility with adequate medical intervention. Here, specific wires called electrodes are taped on the affected area's skin to observe and record nerve signals. Damage to the nerve, blockage or slow down in electrical signal transmission will be noticed.

How Can Carpal Tunnel Syndrome in Pregnancy Be Treated?

When arm and hand functions are affected, adequate treatment, when given at the right time, can help restore functions. Some treatment options and lifestyle modifications are -

• Ice or Cold Therapy - Wrap ice in a cloth and place it on the affected area. Ice helps reduce swelling. A method called contrast bath can also help. Here, dip one's arm in cold water for about 30 seconds, and remove and dip them immediately in hot water for a few seconds. Repeat the action for a few minutes.

• Splints in the Carpal Tunnel - In case of severe pain, the physiotherapist might suggest using splints, and they will teach the right way to use a splint. In splinting, the affected wrist is usually immobilized in a neutral position to limit movement. Splints should be worn during the day as well as at night. The symptoms worsen primarily at night.

• Physical therapies: Myofascial release therapies can also help reduce muscle and ligament stiffness. Myofascial release therapies are similar to massage therapies.

• Medications: In case of severe pain, consult the doctor and take painkillers that are safe during pregnancy.

Other measures include:

• Do not overuse or exert intense pressure on the affected hands. If routine activities include prolonged keyboard use, adequate care should be taken, like stretching the hands every hour.

• Always practice good posture. Measures such as keeping the affected arms on a support pillow while lying down, resting one's arm on an armrest while seated, and not sitting, standing, or moving in uncomfortable positions help.

• Swelling can be reduced through less salt intake or avoiding salty food.

• Most symptoms may gradually reduce and eventually resolve within a few weeks or a year after delivery. If symptoms prevail after a year of delivery, continue using the splints.

What Exercises Are Recommended for Carpal Tunnel Syndrome in Pregnancy?

Always remember to consult a physiotherapist before attempting any exercise. A few exercises that will help with the condition are:

• Place the fingers upright and extend the wrist backward and forward. Try repeating this about ten times.

• Make a fist and then slowly release and straighten the hand repeating this about ten times.

• Make an "O" shape by touching each finger with thumb. One must bring a finger to their thumb one at a time.

• Make a fist, fan the fingers, and stretch as far as possible. Repeat this stretch about five to ten times.

• To increase the strength of the grip, squeeze a pair of soft rubber balls or socks that have been balled up. Hold the squeeze for about five seconds. Repeat the squeeze stretch ten times and do it three times every day.

• As a professional whose work requires repetitive motions, stretch once every hour.

Conclusion:

Carpal tunnel syndrome is a complication that commonly occurs among pregnant women due to edema (swelling due to fluid collection ) during pregnancy. It usually resolves within a year after delivery. Even though it requires careful monitoring, appropriate lifestyle changes and treatment can alleviate the condition. Always consult a doctor or physiotherapist before attempting any exercise or medications to ease the discomfort of the condition.

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