What is carpal tunnel syndrome during pregnancy?
Carpal tunnel syndrome (CTS) is a condition featuring pain, numbness, and/or tingling, in the hand and often the forearm, due to compression of the median nerve, where it passes through the carpal tunnel, a passageway through the carpal bones. CTS can be unilateral (affecting one hand), or bilateral (affecting both hands). Consisting of the scaphoid, lunate, triquetrum, pisiform, trapezium, trapezoid, capitate, and hamate bones, the carpal bones are located at the base of the hand, where the hand connects with the forearm bones (ulna and radius), forming the wrist joint. There is limited space in the carpal tunnel, so compression of the median nerve can happen, either if the carpal tunnel narrows or if the median nerve and other contents of the carpal tunnel enlarge. This can be a vicious cycle, because mechanical irritation of the contents of the tunnel can stimulate inflammation, causing swelling, which puts increased pressure on the contents of the tunnel, including the median nerve. Since the median nerve supplies the thumb (finger 1), plus the second, third, and part of the fourth finger, often people with CTS feel symptoms involving most of the hand and all fingers, except for the little finger (pinky), though its possible to feel symptoms in all five fingers, since pain and discomfort tends to spread out. CTS has a strong association with activities involving repetitive hand movements such as typing. There also is a very strong association between CTS and the third trimester of pregnancy, possibly because of hormonal changes, fluid accumulation (swelling) throughout the body, fluctuations in blood sugar levels, and increased sensitivity of nerves. When you develop CTS during pregnancy, sometimes it is called pregnancy-related CTS (PRCTS).
How common is carpal tunnel syndrome during pregnancy?
Epidemiological studies in various countries have reported CTS present in pregnant women at rates ranging from 2 percent to as high as 70 percent in the third trimester.
How is carpal tunnel syndrome during pregnancy diagnosed?
Diagnosis of PRCTS (or any CTS) is based initially on your history of symptoms (numbness, pain, and other problems with the hand from the thumb side to the fourth finger) and on the physical examination. Additionally, electrical procedures, such as electromyography (EMG) and nerve conduction studies (NCSs), will enable a diagnosis. Doctors also may order imaging studies of the wrist, particularly magnetic resonance imaging (MRI) and ultrasound. While an x-ray of the wrist can be useful to evaluate certain underlying causes of CTS, such as arthritis, it is less useful for examining the carpal tunnel itself.
Does carpal tunnel syndrome cause problems during pregnancy?
Yes, when you have CTS, your symptoms include pain, numbness, and tingling in the hand, and often the forearm, plus the symptoms may reach as high as the shoulder in some people. Although PRCTS is extremely common, the symptoms of CTS that begin in pregnancy often can be mild compared with CTS outside of pregnancy.
Does carpal tunnel syndrome cause problems for the baby?
No. CTS is a problem that is localized to the mothers upper extremity.
What to consider about taking medications when you are pregnant or breastfeeding:
- The risks to yourself and your baby if you do not treat the PRCTS
- The risks and benefits of each medication you use when you are pregnant
- The risks and benefits of each medication you use when you are breastfeeding
What should I know about using medication to treat carpal tunnel syndrome during pregnancy?
Some patients will be inclined to take anti-pain medicines, such as acetaminophen in the United States and paracetamol in several other countries. These medications have only a very limited effect, as do non-steroidal anti-inflammatory drugs (NSAIDs) when taken at low doses that are meant to fight pain but not inflammation. Whereas acetaminophen and paracetamol are fairly safe during pregnancy, NSAIDs, which include ibuprofen and naproxen, especially if taken at the higher doses needed against inflammation, can cause whats called premature closure of the fetal ductus arteriosus, if taken late in pregnancy (after 30 weeks). Unfortunately, late pregnancy is exactly when you would need the NSAIDs to reduce inflammation around the median nerve since PRCTS develops during late pregnancy. Still, even NSAIDs at higher doses are only minimally effective in CTS. A much more effective treatment is an injection of corticosteroids into the carpal tunnel. This is very safe for the baby, and if you have CTS for the first time, steroid injection will be very effective. The catch is that steroid injection should only be used once or twice. If steroids eliminate your symptoms and the symptoms return in several weeks, your doctor will probably agree to try a second injection, but repeated injections of steroids will damage the wrist joint, and the condition will worsen.
Who should NOT stop taking medication for carpal tunnel syndrome during pregnancy?
As noted above, medications are only minimally effective, with the exception of injected corticosteroids.
What should I know about choosing a medication for my carpal tunnel syndrome during pregnancy?
It is important to stay in communication with your health care provider as the release of new studies over time can change the outlook on the role of specific medications during pregnancy.
You may find Pregistrys expert reports about the medications to treat this condition here. Additional information can also be found in the sources listed below.
What should I know about taking a medication for my carpal tunnel syndrome when I am breastfeeding?
Acetaminophen, paracetamol, and NSAIDs are thought to be relatively safe in mothers who breastfeed.
What alternative therapies besides medications can I use to treat my carpal tunnel syndrome during pregnancy?
Except for corticosteroid injection, most of the therapy for CTS is non-medical. The first measure is avoidance or reduction in the number of repetitive movements that causes and aggravates the condition, such as typing on a computer keyboard, tablet, or phone. Additionally, there are various ergonomic devices available that reduce wrist and hand strain, such specially designed wrist supporters and specially shaped computer mice. When these measures do not work, injected corticosteroids are the next step, and finally, there is surgery, performed by a hand specialist, to relieve the pressure in the carpal tunnel. This can be done either with an open procedure in which an incision is made at the base of the palm side of the wrist, and a cut is made in the transverse carpal ligament. Or, it can be done through an endoscopic device, which means that the incision is made more to the side and is slightly smaller. Either method produces a good result, and the choice usually comes down to the preference of the hand surgeon. If you need surgery for CTS in both wrists, it is highly recommended that you get one wrist done at a time so that you can function with the other hand while the hand that had surgery is recovering.
What can I do for myself and my baby when I have carpal tunnel syndrome dur
It is very important to follow the instructions of your physician regarding avoidance of the repetitive activity that causes the condition, such as typing.
Resources for carpal tunnel in pregnancy:
For more information about PRCTS during and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or contact the following organizations: