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.