Carpal Tunnel Syndrome
during Pregnancy
A Painful Problem
By William Hagberg, MD

Excessive skin under the chin, fat ankles and chubby cheeks aren't the only by-products of water retention during pregnancy. Extra fluid can also lead to repetitive strain illnesses (RSIs), a group of ailments that can be an annoying – if not disabling – nuisance for expectant moms. Carpal tunnel syndrome (CTS) is a painful problem that 28 percent of pregnant women have to endure.

What is it?
Carpal tunnel syndrome occurs when the median nerve, traveling through the "tunnel" of the wrist bones, is compressed by the flexor tendons which also run through the carpal tunnel. The nerve responds to this compression by sending back pain signals, and by not carrying normal information, which provides sensation to the hand. All ages can be affected by CTS, although most cases occur between the ages of 29 and 62.

Although highly repetitive wrist movements appear to be correlated with the development of carpal tunnel syndrome, other factors, such as medical conditions like diabetes, rheumatoid arthritis, thyroid disease and pregnancy, may be even more important.

Signs and Symptoms
The following is a list of signs and symptoms about which pregnant women need to be cognizant:

• Tingling or numbness in part of the hand (thumb, index, middle or ring fingers);
• Sharp pains that shoot from the wrist up the arm;
• Burning sensations in the fingers;
• Morning stiffness or cramping of hands;
• Thumb weakness;
• Frequently dropping objects;
• Waking at night with hand pain and numbness;
• Numbness in hand while driving.

The diagnosis of carpal tunnel is suggested by the symptoms listed above. However, not everyone with these symptoms has this condition. Other conditions which cause these symptoms include arthritis or disc disease in the vertebrae of the neck, general problems with peripheral nerves and a compression syndrome of the median nerve closer to the spinal cord than the wrist.

How can you be sure it is CTS?
The definitive diagnostic procedure is a study of the nerve as it goes through the wrist, called a nerve conduction study (NCS). This study will detect over 90 percent of persons with carpal tunnel. However, some people with normal tests will still have carpal tunnel. The history and physical exam is strongly suggestive of CTS and the nerve conduction study tends to confirm the diagnosis and quantify the severity of the nerve compression.

CTS Treatment
Once carpal tunnel is determined, there are a variety of treatments. Splinting serves as the cornerstone of treatment for pregnancy-induced CTS. Studies have shown that resting the fingers, hand and wrist in a neutral position is the most effective way to reduce pressure in the carpal tunnel.

To reduce pain in a mother whose condition hasn't disappeared or in any other sufferer, a specialist or orthopedic surgeon may inject a small dose of cortisone into the wrist.

Persistent carpal tunnel may require surgery that can be performed on an out-patient basis. The procedure is not complex, involving only a small incision made in the palm of the hand near the wrist. As the ligament heals, scar tissue will increase the ligament's elasticity by approximately 25 percent. This procedure allows patients to resume routine tasks within about four to six weeks.

How to prevent CTS
Here are some helpful hints for preventing carpal tunnel syndrome:

• Reducing salt intake allows the body to retain less fluid;
• Change positions frequently;
• Take regular work breaks;
• Vary repetitive tasks to help avoid tweaking the same sore spots continuously.

Pregnant women who develop CTS are not likely to develop this condition again – unless, of course, there is another pregnancy – because the problem usually clears up after delivery. For women who have experienced symptoms prior to their pregnancy, it is possible the problem won't go away and you may need to visit your physician.