Carpal Tunnel Syndrome during Pregnancy

Approximately 31-62% of women experience CTS which is a widespread syndrome. However, it is not a severe condition that causes swelling in the hands and feet. Most will see the symptoms disappear within 12 months after the delivery.

Causes

If one experiences numbness or pain in the hands, it may be due to CTS occurring from the fluid build-up around the wrist tissues called Edema. The swelling presses median nerve running down to the fingers and hand developing numbness and problem while moving the fingers.

It begins in the second and third trimesters which may also continue after the delivery worsening up the condition by affecting the entire hand, especially during morning. One can have it if she has a family history or has problems with the back and neck. The ribcage top gets crossed by median nerve and in case of a broken collarbone, or a whiplash injury, risk of CTS increases substantially. Excess weight gain increases the risk due to extra load on the shoulders or the neck:

  • Expecting another baby
  • Was overweight before pregnant
  • Larger breasts

Symptoms

  • Numbness in the hands, wrists (worsening at the night)
  • A throbbing-sensation in the wrists, and the sides
  • Swelling in the fingers
  • Trouble in gripping objects and problems in performing motor skills.

According to a 2012 study, 50% of women with CTS suffered the problem in both the hands and at least 40% reported the symptoms after 30 weeks while gaining weight.

CTS and Breastfeeding

It may be painful because the mother will use the wrist to hold the baby’s head and the breast for feeding correctly. Try different positions and get support from the pillows if needed. Lie on the sides while feeding or the football hold may be more natural on the wrist. Sit upright with this position and place one on the bottom of the arm with the head close to the torso. If facing trouble, consider talking to a consultant who can help identify the problems with nursing.

Diagnosis

The diagnosis depends on the description of the symptoms by conducting a physical exam where the doctor uses an Electrodiagnosis test to confirm it. The test uses electrodes or thin needles to analyze the signals of the nerves. Any damage to the median nerve can block these signals.

The doctor may also use ‘Tinel’s Sign’ which is safe through a physical examination by lightly tapping over the area to determine the situation.

Risk Factors

  • Being overweight before conceiving
  • Having gestational diabetes and gestational hypertension
  • High blood sugar levels can cause inflammation
  • Higher amounts of Relaxin which helps the cervix to expand causing inflammation in the carpal tunnel.

Treatment

Most doctors treat it conservatively as a woman gets relief in weeks or months after the delivery. According to a study, 1 out of 6 have the symptoms after 12 months of the distribution. The following treatments are needed:

  • Use a Splint: Are the braces that keep the wrist in a neutral position.
  • Avoid activities causing a bend in the wrist (Includes typing on a keyboard).
  • Cold Therapy: Wrap ice for 10 minutes and apply on the affected area to reduce swelling. One may also try a contrast bath involving soaking the wrist in cold water for about 1 minute then in hot for another minute.
  • Rest: Rest or switch to a different activity to prevent the fatigue.
  • Yoga: Strengthens the grip and reduces pain
  • Elevate the wrists: Use pillows to elevate
  • Physical Therapy: Myofascial Release Therapy may reduce the pain by reducing the tightness and shortness in muscles.
  • Pain relievers: Tylenol is often prescribed by the doctor with a maximum of 3000 mg as the dosage. Avoid Ibuprofen unless recommended by the doctor.

Prevention

  • Try eating a protein-rich diet to gain ample weight while avoiding salt, and sugar. Drink 9-12 glasses of water with eating fruits or vegetables every day.
  • Include vitamin B6 rich foods like Hazelnuts, Garlic, Lean meat, Broccoli, Avocados, Whitefish in the diet and supplements to promote a healthy nervous system.
  • Wear a specially designed maternity bra to support the  breastbones and the ribcage.

Tips to Relieve Pain

  • Hand Splints: Wear them at night to stop the hands from curling while sleeping.
  • Freezing water: Place the hands or an ice-bag against the affected area by exercising the fingers and wrists to elevate them. Try putting the leaves of the cabbage on the wrists and leave till wet to relieve swelling and pain.
    Exercises: Massage one wrist in a circular direction to encourage the fluid flow and ease the congestion. Stretch the hands and arms gently at night.
    Massage: Let your partner give a gentle massage on the wrists, hands, armpits, shoulders and the upper back.

Complementary Therapies

Consider choosing a qualified complementary therapist who can provide:

Acupressure and Acupuncture

Acupuncture relieves the pain while Acupressure frequently at pericardium point six can help relax the muscles. To find the perfect point:

  • Count the widths at three finger from the junction between the wrist and hand.
    Look for a dip and pressurize the point
  • Press the plunge firmly for ten seconds
  • Do it three times

Aromatherapy

Add two drops of essential oils like lemon and Cypress in warm water in a cloth as it can reduce swelling

Note: Using the oil of Juniper Berry is not safe as it can affect the kidneys.

Herbal Remedies

Drink Chamomile tea to lower the inflammation, however, it can have an opposite effect if taken too much.

Osteopathy: The practice of chiropractic can re-align the bones, muscles, ligaments and joints. Osteopathy offers relief from the neck and shoulder pain.

Reflexology: Lacks the evidence that its useful but is a relaxing treatment by a Reflexologist or one can try techniques like:

  • See the upper side of the foot and hand
  • Imagine a line from the base until finished finding the tenderness.
  • Put pressure on the center of it with thumb till it disappears
  • Repeat the process 4-5 times

CTS ICD-9 & ICD-10 Codes

  • ICD-9 code is 354.0
  • ICD-10 code is G56.01

References

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