Unexpected Pangs of Pregnancy

Why Carpal Tunnel Syndrome Risk Increases During Pregnancy

Pregnancy brings many unexpected surprises. It is difficult for physicians to communicate all  potentially related conditions that may occur and how they may impact each woman. One of those conditions is carpal tunnel syndrome (CTS).

CTS is the result of compression occurring within the narrow carpal tunnel located at the wrist – through which one of the major nerves in the arm, the median nerve, passes. This nerve becomes irritated in the compressed tunnel and can cause numbness, pain, tingling and weakness in the thumb and certain fingers.

Compression on the median nerve as it passes through the narrow carpal tunnel.

While CTS occurs in just five percent of the general population, it affects 31 to 62 percent of pregnant women, according to a study reported in BJOG, an international journal of Obstetrics and Gynecology.1

There is little consensus on why CTS is so prevalent during pregnancy, but hormone-related swelling is the suspected culprit. The same fluid retention swelling affecting ankles and fingers during pregnancy can also cause swelling and corresponding compression within the narrow carpal tunnel, resulting in CTS.2,3

Some of the common symptoms of CTS in pregnancy may include:

  • Numbness and tingling (pins-and-needles sensation) in the thumb, index finger, middle finger and radial half of the ring finger.
  • Throbbing sensation in the wrists and hands, which may become worse at night.
  • Swelling in the fingers.
  • Difficulty gripping objects and performing such tasks as buttoning a shirt or opening the clasp on a necklace.

CTS can affect one or both hands.   A study appearing in the journal of Advanced Biomedical Research reported that almost 50 percent of pregnant participants with CTS experienced the condition in both hands.4

Carpal Tunnel Syndrome Diagnosis and Treatment

CTS is easily diagnosed and includes a history of the symptoms and a physical examination.  It may also include sensation testing on the hand, as well as sensory testing of the forearm and arm.  Other tests may include the Phalen’s maneuver, the Tinel’s test and a compression test.  Electrodiagnostic studies (EMG) may also be used to confirm diagnosis.

Physical examination for Carpal Tunnel Syndrome.

Conservative treatment is used in the initial diagnosis of CTS, particularly in pregnant women.  This may entail wrist splinting at night followed by steroid injection in the carpal tunnel if unresolved.

Most women experience symptom relief following delivery and/or breastfeeding.  Though, some women may experience symptoms for months after – and in some cases up to three years.  In those experiencing chronic CTS-related pain that hinders day-to-day activities and remains unresolved by conservative treatment, a minimally invasive procedure known as Endoscopic Carpal Tunnel Release may be considered.  A discussion with a hand specialist can help determine the best course of action.

References

  1. Meems M, Truijens SEM, Spek V, Visser LH, Pop VJM. Prevalence, course and determinants of carpal tunnel syndrome symptoms during pregnancy: a prospective study. BJOG. 2015 17 March. https://doi.org/10.1111/1471-0528.13360
  2. Zyluk A. Carpal tunnel syndrome in pregnancy: a review. Pol Orthop Traumatol. 2013 Oct 7;78:223-227.
  3. Ablove RH, Ablove TS. Prevalence of carpal tunnel syndrome in pregnant women. WMJ. 2009 Jul;108(4):194-196.
  4. Khosrawi S, Maghrouri R. The prevalence and severity of carpal tunnel syndrome during pregnancy. Adv Biomed Res. 2012. Aug 28;1:43.

Dr. Korsh Jafarnia is one of Houston’s leading board certified, fellowship trained hand and upper extremity specialists.  A member of Houston Methodist Orthopedics & Sports Medicine, Dr. Jafarnia is affiliated with Houston Methodist Hospital at Memorial City/Spring Valley.  He also serves as an assistant professor, Weill Cornell Medical College. Call 888.621.4263 for an appointment.

This information is made available for educational purposes only.  It does not serve as a diagnosis in the absence of a consult with a qualified healthcare provider.

 

 

A Roadmap to Staying Pain Free on Long Rides

Avoiding Possible Pitfalls as Upcoming Bike MS 150 Takes Cyclists of Varied Skill Levels on Two-Day Trek Across Texas

 The 2021 Bike MS 150, previously the BP MS 150, is scheduled for May 1 in Houston and expected to host thousands of cyclist of varied skill levels.  This requires lots of preparation … and patience.Repetitive stress conditions cyclists experience.

While we have written over the years about some of the common hand, wrist and elbow injuries and conditions avid cyclists experience, there are additional considerations following a year that paused many of the training activities previously available. Less training sets the stage for mishaps and repetitive stress conditions.

Recognizing the areas of vulnerability following the 2020 pandemic “pause” can help riders modify behavior and reduce risks.

Repetitive Stress
Nearly one-third of the overuse strains associated with avid cyclists competing year-round in weekend rides and races affect the hand and upper extremity. These types of injuries can also affect those who have not adequately trained yet embark upon a 150-mile ride between Houston and, this year, the Texas A&M College Station campus.

The constant vibration, griped hand position for hours at a time or tense ride into the wind, up a hill and alongside Interstate traffic and inexperienced riders can result in such repetitive stress conditions as carpal tunnel syndrome or handlebar palsy, also known as ulnar neuropathy.  Cold weather also makes tissue more distensible and may slightly increase risk for carpal tunnel syndrome as well.

Carpal Tunnel Syndrome
One of the most common tendinopathic conditions associated with overuse activity and repetitive stress in the hand and wrist is Carpal Tunnel Syndrome (CTS).  CTS is one of the most common overuse hand and wrist conditions affecting cyclists.Median nerve and carpal ligament in the hand.

The result of irritation and swelling, CTS causes compression within the narrow carpal tunnel located at the wrist – through which the median nerve, one of the major nerves in the arm, passes. When the median nerve becomes irritated in this compressed and subsequently inflamed tunnel, numbness, pain, tingling and weakness may result in the thumb, index and middle fingers.  This may cause discomfort, affecting a cyclist’s ability to even shift gears with the affected hand.

Resting periodically and stretching the hands, as well as changing grip and handlebar positioning to reduce hyperextension and hyper flexion may help during the ride. But ongoing pain may require treatment, which is generally nonsurgical and may entail night bracing and/or injection therapy.  Chronic carpal tunnel syndrome following nonsurgical treatment may require a minimally invasive procedure known as Endoscopic Carpal Tunnel Release.

 Handlebar Palsy (Ulnar Neuropathy)
Handlebar palsy, known medically as ulnar neuritis or neuropathy, is another common overuse or repetitive stress condition affecting cyclists.  This results when direct pressure is placed on the ulnar nerve at the hand and wrist – from the grip of a cyclist’s hands on handlebars, causing stretching or hyperextension of the nerve.

The ulnar nerve controls sensation in the ring and little fingers as well as the muscular function of the hand.  Compression of this nerve can cause numbness and tingling in the ring and little fingers, as well as hand weakness. Nonsurgical treatment such as rest, stretching exercises, and anti-inflammatory medications generally resolves this condition.Handlebar palsy affects the ulnar nerve.

These overuse, repetitive stress conditions affecting bicyclists also often affect motorcyclists as well, as the continuous vibration of the motorcycle causes the same type of conditions that long rides and regular bicycling can cause.

 Other Riding Tips for Reducing Risks
Professional cyclists and medical experts have contributed to an array of preventative tools and recommendations for reducing risks for such conditions.

These include:

  • Cycling gloves – both basic or specialized gel cycling gloves to reduce pressure on the ulnar nerve.
  • Additional handlebar padding.
  • Custom adjustments in handlebar height and overall bike fit specific to each rider.
  • Applying less pressure or weight to the handlebars and avoiding hyperextension and hyper flexion.
  • Frequent adjustments to grip and position on the handlebars during a ride.
  • Hand exercises between rides, such as squeezing an Isoball.

Dr. Korsh Jafarnia is one of Houston’s leading board certified, fellowship trained hand and upper extremity specialists.  A member of Houston Methodist Orthopedics & Sports Medicine, Dr. Jafarnia is affiliated with Houston Methodist Hospital at Memorial City/Spring Valley.  He also serves as an assistant professor, Weill Cornell Medical College. Call 888.621.4263 for an appointment, or go to www.korshjafarniamd.com to learn more. 

This information is made available for educational purposes only.  It does not serve as a diagnosis in the absence of a consult with a qualified healthcare provided.