Carpel Tunnel Syndrome and Pregnancy
It is not unusual for women who suffer from carpal tunnel syndrome (CTS) to notice an increase in symptoms when they are pregnant or for women who have never had CTS to develop carpal tunnel-like symptoms.
It is important to make a differentiation between true CTS and pregnancy-related symptoms. CTS is most commonly caused by overuse of the wrist coupled with poor body mechanics. Symptoms associated with pregnancy are not necessarily connected to your job or other activities, although certain activities may aggravate the symptoms. Pregnancy-related symptoms are caused by the increase in fluid retention and ligament laxity. This allows for more swelling in the carpal tunnel, which is already cramped for space. The additional pressure on the vessels and nerves produce the symptoms of pain, numbness, tingling, weakness, etc . . .
Stretches and exercises for the wrist are very helpful in alleviating the discomfort, promoting proper blood flow to the area and decreasing the accumulation of fluid. Ice or heat compresses may offer some relief, as may support braces. The braces are often most beneficial when used at night while sleeping, since this is often when symptoms are increased. Therapeutic ultrasound is often used to help to decrease the swelling. Manipulation of the wrist is also very beneficial. This will ensure that all the bones in the wrist are in correct alignment. Very often with the increase in ligament laxity and the increase in fluid, the bones become out of alignment or 'subluxated'. This only compounds the problem by causing more crowding in the carpal tunnel.
Symptoms associated with pregnancy and even the increase in true CTS symptoms usually resolve themselves within 6 weeks post partum. Occasionally they will persist and require more extensive therapy, however there is rarely a need for surgical intervention. The best way to ensure that the symptoms do not persist after pregnancy is to receive treatment during the pregnancy. If the vessels and nerves are compressed for long periods of time without relief, permanent damage is more likely to occur. Most chiropractors are knowledgeable about CTS, but you may feel more comfortable with a chiropractor that specializes in caring for women during pregnancy.
Carpal tunnel syndrome or CTS is a condition where the "tunnel" through which the median nerve passes becomes natrowed at the wrist. The narrowing presses on the nerve and makes certain fingers and parts of the hand ache or tingle, especially at night or in the dawn hours. CTS can arise from unknown ("idiopathic") reasons or from over-use of the hand in certain jobs or hobbies where repetitive movements strain the wrist tissues - as with knitting, keyboard inputting, housepainting, racquet sports and operating hand-held power tools such as drills, hammers or chain saws. Such repetitive strain injuries are frequently seen among miners, roadmenders and others who use hand-held tools that vibrate. CTS can also arise by sleeping on the hand in a certain position and may accompany some diseases.
Tingling fingers may herald carpal tunnel syndrome
The first hint of carpal tunnel syndrome may be a buming numbness and tingling ("pins and needles"), as if some fmgers and parts of the hand had "gone to sleep." Symptoms of carpal tunnel syndrome occur because the median nerve is compressed as it passes through a narrow tunnel of bone and ligament at the wrist. The result is numbness, tingling and perhaps pain in the thumb, middle and index fingers, sometimes in all five fingers. Symptoms most often occur at night or in the early morning, making people shake their hands to get rid of the irritating sensation. Shaking or massaging the hand may give temporary relief, but if ignored, CTS can progressively worsen. It commonly affects both hands, the dominant (most-used) one more severely.
The CTS symptoms may appear after any movement that keeps the wrist over-extended for long periods - as with stitching, painting, operating a drill, saw or computer keyboard. The tingling sensation of CTS tends to worsen on flexing or extending the wrist, subsiding when the hand is at rest, in a "neutral" position. CTS can also be set off or aggravated by anything that makes the wrist tissues swell and compress the median nerve in its narrow passageway through the wrist. Fluid accumulation during pregnancy or before a menstrual period, a Coiles' (wrist-bone) fracture, gout, arthritis, diabetes and adrenal or thyroid diseases can cause an acute bout of CTS which often vanishes once the underlying condition improves or is effectively treated.
Besides being annoying, the sensory loss may lead to injuries or bums (due to a lessened sensation of pain and pressure), and the muscle wasting can make wrist movements clumsy. As CTS progresses, wrist and thumb strength may seriously decline. A typical case is Jeff, a carpenter, who experienced pain and numbness in his middle and index fingers on awakening, which disappeared when he shook the hand or raised it above his head. But the pain slowly increased, his grip weakened, and he began dropping things - even his favorite mug. Eventually the discomfort persisted all day and drove him to see his doctor, who referred him to a neurologist. The specialist prescribed a splint to be worn at night, but eventually Jeff needed surgery to relieve the problem.
Diagnosis of carpel tunnel syndrome
It's best to seek medical attention at once for any frequent or persistent tingling in the fmgers or hand. Clinical diagnosis of CTS is often complicated as the condition can arise from arthritis in the neck rather than median nerve (wrist) compression. But the typical night-time or early motrang hand tingling, and use of certain tests help to confirm CTS. Phalen's test is done by flexing the hands upwards at 90 degrees to see if and when the tingling starts; Tinel's test involves tapping the median nerve at the wrist to see if it produces tingling. The sooner the tapping induces tingling, the more serious the condition. Diagnosis must be confirmed with a nerve conduction study - where a small electric current is applied at different spots along the median nerve to assess nerve conduction and an electromyogram or EMG - with an electrode in the muscle to determine whether and how much nerve damage has occurred. A delayed response (slow conduction) through the carpal tunnel reveals conduction delay and possibly nerve injury. An abnormal EMG indicates muscle impairment from the decreased nerve supply. Treatment options for carpel tunnel syndrome Treatment of CTS usually begins with a splint, worn at night and perhaps also during the day. If symptoms don't subside, the physician may recommend surgery. "If there's only delayed nerve conduction," notes one expert, "conservative treatment may be enough; but if the EMG shows nerve damage, surgery is often advisable." Conservative treatment means wearing a light, plastic wrist splint (fastened by velcro strips), and possibly use of anti-inflammatory cortisone injections. Splints can remedy CTS by holding the wrist in position. Both night and occupational splints, specially crafted by occupational therapists to fit the individual's hand, keep the wrist in a "neutral" position reducing pressure on the median nerve. Occupational splints are job specific. Other helpful strategies include altered sleep positions and avoiding movements that increase pressure on the median nerve. With correct therapy, time and patience, the loss of nerve conduction can often be reversed by simple measures. Sometimes, operating tools in a more "neutral" wrist position, helps to alleviate the problem. Modern designers work on vibration-dampeners, shock absorbers and other ways to lessen the wrist-damaging movements of hand held tools.
If medical strategies fail to correct CTS, physicians may recommend surgery to decompress and release the nerve from pressure - a simple procedure (if done by experienced operators) performed under general or local anesthetic. The operation divides the ligaments forming the roof of the "tunnel" through which the nerve passes in the wrist, setting free the trapped nerve, often with rapid post-surgical relief. After a few days, stitches are removed, but splinting may still be needed until the wound heals and the pain subsides. In some, residual pain may persist for some time after the operation.
Carpal tunnel syndrome affects 2533% of pregnant women. It occurs when the median nerve, travelling through the "tunnel" of the wrist bones, is compressed by the flexor tendons which also run through the carpal tunnel. The nerve responds to this compression by sending back pain signals and by not carrying normal information which provides sensation to the hand.
This results in numbness and/or pins and needles in the fingers and hands, generally first thing in the morning. This is termed "mild and while annoying, is usually not incapacitating. The same cannot be said of the more severe forms of the condition where the pain is so severe that sleep can be disturbed and hand movements are severely restricted. The symptoms can also include sharp pains that shoot from the wrist up the arm, thumb weakness, frequently dropping objects, waking at night with hand pain and numbness in the hands while driving.
Hand Exercises: What can be done about it?
Here are some remedies which might be helpful:
Hold your fingers stretched out as far as possible for a few seconds, then relax them.
Make a fist, then straighten out your fingers.
Move your hands up and down and from side to side and round and round. Try flicking them quickly.
Keep your hands raised as much as possible improvise an elevation sling with a scarf. In bed try sleeping with your hands slightly raised on pillows.
Try bathing your hands/wrists in a bowl of hot water (around 38oC) for about 3 minutes. Then immerse them in cold water for about 30 seconds. You should then repeat this sequence twice more, increasing the temperature of the hot water to a maximum of 43oC (dont burn yourself!) and adding ice to the cold water to keep it cold.
Wear a splint/wrist support, supplied by your midwife. Studies have shown that resting the fingers, hand and wrist in a neutral position is the most effective way to reduce pressure on the median nerve.
Acupuncture or acupressure helps some women.
Make sure you are eating a full and balanced diet, containing the full range of vitamins. There is some evidence that taking B complex vitamins by mouth has helped to relieve the pain and numbness/tingling of carpal tunnel syndrome. B vitamins are used in nerve metabolism and if you have a relative deficiency, increasing your intake may improve nerve function.
If the condition is very severe, your doctor may prescribe a diuretic drug to help you lose some excess fluid. Sometimes ultrasound treatment may relieve the symptoms.
After pregnancy
Carpal tunnel syndrome usually improves, often very quickly, after pregnancy ends. You are not likely to develop this condition again unless, of course, you get pregnant again and even then, you might or might not. For women who have experienced symptoms prior to pregnancy, it is possible the problem wont go away and only then would the last resort treatment of surgery be undertaken.