Swelling is one of the most common symptoms of pregnancy. Patients often notice swelling in their ankles and feet, but for some women, swelling occurs inside the wrist, resulting in a condition known as carpal tunnel syndrome (CTS).
Approximately 4% of adults in the general population have carpal tunnel syndrome, but almost 30% of women will develop carpal tunnel symptoms in the last trimester of pregnancy.
The carpal tunnel is located in the wrist. The floor of the tunnel is made up of 8 small carpal bones. The roof of the tunnel is a strong ligament. Running through this tight space is a major nerve (median nerve) and 9 tendons which bend the fingers and thumb.
During pregnancy, blood volume doubles and that extra fluid increases pressure and swelling in the blood vessels throughout the body. In tight spaces such as the carpal tunnel of the wrist, swelling can cause compression of the median nerve. The median nerve gives sensation to the palm-side surface of thumb, index and middle fingers, and half of the ring finger. Compression of the median nerve can cause pain, tingling, and numbness in the wrist and hand, which may increase at night when trying to sleep.
When managing CTS, it is best to start with conservative treatment options and this is especially so in pregnancy. The first-line treatment is to support the wrist in a neutral position. Splinting avoids extreme wrist positions that can aggravate the median nerve and can help alleviate swelling, which can allow mild to moderate neural symptoms to settle. However, it is often not feasible to wear a splint while performing everyday activities. We recommend wearing the splint while sleeping, and as often as practical during the day.
Carpal tunnel release surgery may be indicated for severe cases (worsening symptoms, permanent numbness, limited function, or muscle wasting in the hand). In this procedure, a surgeon will cut the ligament that forms the roof the carpal tunnel, making more room for the median nerve and tendons to move. This procedure usually improves function and pain. Generally, we recommend waiting 2 months after pregnancy to have surgery. This is because for most women symptoms will improve post-partum.
Research has found that 85% of women will have their carpal tunnel symptoms resolve by 6 weeks post the birth of their baby. A smaller percentage (15%) will have ongoing tingling and numbness after one month.
If you are experiencing carpal tunnel symptoms during pregnancy and would like to discuss this with one of our hand therapists, please phone 355 9775 to make an appointment.
