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.

 

 

Unexpected… Pregnancy Related Hand & Wrist Problems, Part 3 (Trigger Finger)

This is the last part of a three-part series on unexpected hand and wrist conditions experienced during pregnancy.  We have focused in this series on three of the most common conditions expectant moms may experience, Carpal Tunnel Syndrome, de Quervain’s Tendonitis and Trigger Finger.

Last month we discussed deQuervain’s Tendonitis and the non invasive ways in which we address the condition – and prior to that Carpal Tunnel Syndrome.  In this last part of the series, we focus on Trigger Finger.

Any one of these conditions may be prompted in expectant moms as a result of the hormonal changes, increased blood flow and water retention and swelling in the body during pregnancy.

Trigger Finger is a disorder characterized by snapping and locking of the flexor tendon of the affected finger or thumb. The term Trigger Finger comes from the unlocking of the finger, in which case it pops back suddenly as if releasing a trigger.

Trigger Finger is the result of inflammation of tendons connecting muscles of the forearm to the finger and thumb bones.  This connection permits movement and bending. While in most cases the inflammation is the result of a repetitive or forceful use of the finger or thumb, medical conditions causing a change in tissues – such as pregnancy – may also prompt Trigger Finger.

One of the early symptoms of Trigger Finger is soreness at the base of the finger or thumb, followed by painful clicking or snapping when flexing or extending the affected finger.  Occasionally there may be swelling.  Periods of inactivity may make this worse, though eases with movement.  In more severe cases, the affected finger or thumb may lock in a flexed or extended position – and forced to straighten.  Joint stiffening may eventually occur.

Diagnosing and Treating Trigger Finger

Diagnosing Trigger Finger is done with a physical examination of the hand and assessment of the symptoms.

Treatment for Trigger Finger is generally conservative and may include:

  • Avoiding activity that aggravates the affected finger or thumb
  • Anti-inflammatory medication
  • A steroid injection into the tendon sheath

If conservative treatment is unable to resolve the condition, a minimally invasive surgical procedure to release the tendon sheath may be indicated.  Expectant women are advised to wait before considering surgical treatment as often times the condition is resolved following pregnancy – when the body resumes normal function.