What is Carpal Tunnel Syndrome?
Carpal tunnel syndrome is a common condition that occurs when there is too much pressure on the median nerve in one or both wrists. It may include symptoms of; tingling, numbness and pain in the wrists, hands and fingers.
The term carpal tunnel refers to a small corridor running to the wrist inside the forearm. It is comprised of the carpal bones at the top of the tunnel and the transverse carpal ligament on the underside of the tunnel. Tendons, blood vessels and the median nerve all occupy this small space and each structure contributes to the function of the hands and wrist.
Pregnancy & Carpal Tunnel Syndrome
Carpal tunnel syndrome is also very common during and after pregnancy. In fact, one in four pregnant women may experience carpal tunnel syndrome, most often during the second or third trimester and in some cases several days after the baby’s birth. Development of carpal tunnel during a pregnancy or post-partum also means it is more likely to recur in future pregnancies.
During pregnancy, blood volume increases by up to 50 percent in order to nourish the uterus, placenta and baby. The extra blood volume and retention of extra body fluid (oedema) in wrist tissue can increase the pressure within the carpal tunnel and therefore impact upon the health and function on your hand and wrist nerves.
The build-up of oedema in wrist tissue and the carpal tunnel during pregnancy can compress the median nerve which runs to your hand and fingers, leading to carpal tunnel syndrome. The symptoms may be exacerbated if repetitive hand and wrist movements occur for a significant amount of time, for example typing for many hours at work.
There are other factors that may increase the likelihood of developing carpal tunnel syndrome during pregnancy. One of these includes obesity. If the pregnancy leads to gaining even more than average weight due to expecting twins or a particularly heavy baby, and also an increased bust size during pregnancy can add significant weight and fluid build-up.
How do I know if I have Carpal Tunnel Syndrome?
The primary symptoms of Carpal Tunnel syndrome may include sensations of tingling, pain or numbness, and weakness, resulting in difficulty gripping objects and moving fingers. Pain, pins and needles and weakness is often concentrated in the thumb, index and middle finger and half of the ring finger as well as in the wrist itself. Symptoms are generally worse at night, and symptoms tend to be stronger on your dominant hand side.
Carpal tunnel is diagnosed by these painful symptoms in conjunction with a number of non-invasive tests and a physical assessment done by a Hand Physiotherapist. Depending on symptoms and circumstance, an ultrasound may be advised in order to check for irregularities in the wrist. Unclear symptoms may require a nerve conduction study in order to determine precisely what problem is occurring.
How can I manage my Carpal Tunnel Syndrome in Pregnancy?
Being fitted for a high-quality, supportive maternity bra can help to reduce the pressure on your rib cage and breastbone, which in turn reduces the pressure on the nerves that supply the shoulder and arms, thereby reducing symptoms.
Treatment for carpal tunnel may include using a wrist splint to enable the wrist to rest, thereby reducing the swelling in the tunnel. A splint will maintain the wrist in the best position to minimise the pressure within the tunnel. Your Hand Physiotherapist may also use manual treatments to reduce inflammation and swelling, improve movements in the hand and wrist and to maintain the strength of the hand and wrist.
Home exercises to help alleviate symptoms including: icing the hand and wrist, elevating the hand and wrist and gently exercising to try to restore some flexibility and strength may also be incorporated in the management for Carpal Tunnel Syndrome. If these methods are not effective, steroid injection of cortisone, diuretics and surgery may be considered in consultation with a Hand Surgeon.
In most cases, symptoms of carpal tunnel syndrome will subside following delivery of the baby, as the fluid build-up during pregnancy lessens back to regular levels. However, in some cases this drawdown of symptoms after pregnancy can take up to three months, so treatment, if the pain and symptoms is severe, is advisable. It should be noted that having carpal tunnel syndrome during pregnancy will not harm your baby in any way.
Further discussion with your Hand Physiotherapist on how to manage symptoms and adapt your household and work activities to work around the condition and alleviate its symptoms can be very helpful.
About The Author: Sophie Halsall-McLennan is the owner of Fresh Start Physiotherapy (http://www.freshstartphysio.com.au/). She has a special interest in hand therapy and back pain treatment and has a Bachelor of Physiotherapy from Charles Sturt Physiotherapy, over 12 years of clinical experience as a Physiotherapist and is registered with AHPRA. She is also a Lecturer at Deakin University.