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.

 

 

The Texas Bowl, Championing Community

Stemming from a rich history that dates to 1959, the Texas Bowl we know today champions community and charitable initiatives – designating the Depelchin Children’s Center as its charitable beneficiary.

A post-season NCAA-sanctioned Division I FBS college football bowl game, the Texas Bowl takes top tier performance off the field to strengthen the Texas communities they call home.

Aside from the direct support provided the Depelchin Center through its ticket sales, the Texas Bowl community initiatives include; the Kendra Scott Gives Back event, Gridiron Legends – honoring epic players in Texas football, Gridiron Legends Golf Tournament, Mr. Football – Player of the Year Award, Day at the Museum, Team Football, Rodeo Bowl, Bowl Buddy and THSCA Tickets – Texas Bowl tickets offered to outstanding coaches through the Texas High School Coaches Association & Coaches Education Foundation.

Together the Texas Bowl has contributed over $1.6 million in financial support to the center and millions of dollars in promotional support, while boosting spirits and empowering children from the Depelchin Center throughout the year – something needed today more than ever before.

The Depelchin Center, which has been a beneficiary of the Texas Bowl since 2006, has served as one of Houston’s leading centers for foster care and adoption services since 1892.  The center is a nonprofit provider of mental health, prevention and early intervention and child welfare services.

Texas Legends

The Gridiron Legends program honors individuals who have made a significant contribution to the game of football in the state of Texas (high school, collegiate or professional). 

The 2020 Gridiron Legends class will be honored on-field during the 2020 Texas Bowl, which is scheduled for December and currently taking names for the Priority Waiting List.

The History of the Texas Bowl

The Texas Bowl played its first game in 2006, replacing the Houston Bowl (2000-2005).  Prior to that, the bowl was called the Bluebonnet Bowl (1959 – 1987).  It has had different title sponsors over the years including AdvoCare (2014-2016), Meineke Car Care (2011 – 2012) and currently Academy Sports + Outdoors (2017 to present).  The bowl game today is officially called the Academy Sports + Outdoors Texas Bowl.

Dr. Jafarnia has recently joined the board of directors of the Texas Bowl – committed to ensuring the success of the organization and vital role it plays in improving community and the lives of Houston kids.

Dr. Korsh Jafarnia plays with golf legend Calvin Murphy in the Gridiron Legends Golf Tournament

Dr. Jafarnia (second from right) with golf legend Calvin Murphy (center) and colleagues at the 2019 Gridiron Legends Golf Tournament.

Learn more about the Texas Bowl, the Depelchin Children’s Center and the center’s current School Supply Drive.

 

 

 

 

 

The Different Types of Fractures

A fracture is a break in the bone. Within the hand and upper extremity it can occur anywhere from the fingertip to the shoulder.

Among the most common fractures and dislocations of the hand and upper extremity include:

  • Finger Fractures
  • Distal Radius Fractures (also called Colles Fracture)
  • Scaphoid Fractures
  • Forearm Fractures
  • Clavicle Fractures (collar bone)

There are a number of different types of fractures – partial or complete, simple or compound, clean or shattered …each with their own classifications.  It is important to first define the type of fracture and its severity before determining the most effective treatment plan.

Fractures are defined by the severity of the break and the impact it imposes to surrounding tissue. Some fractures known as partial fractures may only cause a slight crack in the bone, while others may result in a complete break or shattered bone.

A fracture may also be either open or compound, which is a fracture that pierces through the skin creating an open wound.  A closed or “simple” fracture is a fracture that does not break through the skin.

Other classifications that help determine the best treatment plan for your type of fracture include:

  • Transverse Fracture – A fracture that goes across the bone and is situated at a right angle to the long axis of the bone.
  • Greenstick Fracture – A fracture situated on only one side of the bone, causing a bend but not a complete break. These are most commonly seen in children with more “pliable” bones.
  • Comminuted Fracture – A fracture that results in three or more bone fragments.
  • Intra-articular Fracture – A fracture with joint involvement.

Depending on the severity of the fracture, treatment may entail the non surgical realignment of the bone and casting, also referred to as closed reduction. Or surgical repair utilizing fixation support may be indicated.