Carpal Tunnel Syndrome During Pregnancy: Tips & Tricks to Ease the Pain
International Journal of Childbirth Education, March 2010
by Heather Jeffcoat, DPT
Carpal Tunnel Syndrome (CTS) during pregnancy is a commonly overlooked problem by healthcare practitioners. It presents as mild to severe pain, numbness, and sometimes weakness in the hands, wrists and forearms along the distribution of the median nerve. At times, the muscles in the forearm ache due to compensations in movement or activity that may result.
The pain can occur at night, further disrupting sleep patterns. These symptoms may arise due to postural changes, increased edema, occupational stressors, or a combination of these. Often patients are told their symptoms will resolve after delivery. Although this is usually the case, patients can perform a few simple exercises that may ease or even eliminate this pregnancy complaint.
When Carpal Tunnel Syndrome occurs in the general population, it is most often associated with the stresses of repetitive motion such as typing, using a computer mouse, work related tasks, or even hobbies as diverse as cooking, knitting, bowling, or tennis (it can also manifest in the elbow as "tennis elbow").
Pregnancy and Carpal Tunnel Syndrome
When manifesting during pregnancy, CTS due to edema tends to worsen in the third trimester, and it often occurs bilaterally. (Turgut, et al 2001). Since edema worsens when the upper extremity is placed in a gravity dependent position, instructing your patient to elevate her arms is a good place to start. Rolling an ice cube over the wrist, called ice massage, can also reduce local swelling.
Exercises to improve flexibility may provide additional relief. Specific areas to include are the postural muscles as well as wrist and elbow.
Doorway Stretch:
Hold onto doorframe as pictured above for 30 seconds. Perform 3 repetitions 2-3 times daily.
Wrist flexor stretch:
Pull fingers back as shown. Hold a gentle stretch for 30 seconds. Perform 3 repetitions, 2-3 times daily.
Resting posture of the wrists should also be given consideration. At night, some women have the tendency to curl their wrists into a flexed position. Since they are sleeping, the best way to ensure their wrists stay in a neutral position is through the use of wrist splints. The ideal splint would have stays to keep the wrist from moving into flexion or extension, thereby keeping it in a neutral position. As an inexpensive alternative, some women are able to prevent the flexed wrist posture by sleeping with a pillow between their hands.
If a patient's symptoms do not improve with the above techniques and exercises or if the symptoms are severe, additional intervention may be required. Presence of numbness and tingling warrants follow-up with a physician immediately to rule out more severe causes of her symptoms. A women's health physical therapist may then be recommended to provide a directed treatment plan. If you don't know of one in your area, contact the American Physical Therapy Association Section of Women's Health at
References
Stephenson, R., O'Connor, L. 2000. Obstetric and Gynecologic Care in Physical Therapy. New Jersey: Slack, Inc.
Turgut, F., Cetinsahinahin, M., Turgut, M., Bolukbasi, O. 2001. The management of carpal tunnel syndrome in pregnancy. Journal of Clinical Neuroscience 8:4 332-334.
