Are carpal tunnel problems common in pregnancy?

• During pregnancy, many women suffer from symptoms of carpal tunnel syndrome due to a number of changes that occur in a woman's body.
• Treatment of carpal tunnel problems during pregnancy is usually conservative as the problems usually disappear after childbirth.
• In the event that carpal tunnel syndrome problems do not disappear after pregnancy, surgery will be necessary.

Carpal tunnel syndrome is the collection of numerous symptoms caused by compression of the median nerve. The median nerve travels from the forearm into the hand through a very narrow channel. The base of this narrow tunnel is formed by the bones of the wrist and the roof of the tunnel is covered by the transverse carpal ligament.

In addition to the median nerve, the tendons that flex the fingers also travel through this canal. The median nerve controls sensation in the palmar aspect of the thumb, index and middle fingers and the function of the muscles at the base of the thumb. The flexor tendons, as the name implies, flex the fingers of the hand. 

When the synovial membrane that surrounds and lubricates the flexor tendons and facilitates finger movement becomes inflamed, it narrows the carpal tunnel space, compresses the median nerve and causes very uncomfortable symptoms for the patient.

During pregnancy, hormonal changes cause several physical changes, including swelling of the tissues caused by fluid retention. Considering that the carpal tunnel is very narrow, if the patient retains fluids and the tissues become swollen, the possibility of compression of the median nerve will be greater.

According to studies, 20-50% of pregnant women suffer from pain, tingling, numbness in the wrists. 

The onset of carpal tunnel syndrome is more likely during the third trimester of pregnancy. Apart from hormonal changes and fluid retention, genetic inheritance is a very important factor in the development of this disease. Some people have smaller carpal tunnels. 

Repetitive movements, previous hand fractures, certain systemic diseases such as diabetes, rheumatoid arthritis and thyroid problems increase the risk of carpal tunnel syndrome during pregnancy.

The main symptoms of this condition are pain, numbness, tingling in the affected wrist area. The pain starts around the thumb, index and middle fingers and radiates to the forearm and elbow. Many pregnant women with carpal tunnel syndrome notice weakness in the fingers and wrist.

The pain and sensation of numbness is aggravated when the pregnant woman uses her hand or wrist and tries to grasp an object. The symptoms are more bothersome at night because, as previously mentioned, many people sleep with their wrists flexed, increasing the likelihood of inflammation of the synovial membrane. It is important to try not to fall asleep on your hands.

Some movements are particularly painful or severe pain may prevent the performance of these movements such as buttoning a shirt or blouse, writing with a pen or pencil, turning a key in the lock, opening a jar of food, brushing hair or knotting a tie.

This pathology in pregnant women is usually bilateral as fluid retention and tissue swelling appear in all parts of the body. In non-pregnant people, carpal tunnel syndrome can be unilateral or bilateral.

In pregnant women, it is not only fluid retention and tissue swelling that play a role, but also postural changes caused by pregnancy, such as slumped shoulders that can pull on the brachial plexus. Changes in the concentration of calcium and magnesium in the blood during pregnancy also play a role in the onset of carpal tunnel symptoms.

The symptoms of carpal tunnel in most cases disappear within a few days after childbirth, taking into account that its causes, such as hormonal changes, fluid retention and tissue inflammation also disappear after childbirth.

The mainstay of treatment for carpal tunnel syndrome during pregnancy is immobilisation of the wrist with splints. The splint or immobiliser is very useful at night because it prevents the wrist from bending during sleep.

To avoid fluid retention, it is advisable to reduce salt intake. Regarding the use of different types of diuretics, it is advisable to seek the advice of a gynaecologist.

Vitamin B6-based food supplements have neuroprotective effects. Some supplements contain magnesium together with vitamin B6. Magnesium helps to relax painfully contracted muscles in the hand. It is important to consult your gynaecologist before taking any kind of food supplement.

If the pain is very intense and unbearable, local steroid infiltration of the carpal tunnel can be considered, which rapidly reduces the inflammation of the tissues and thus reduces the patient's symptoms. The effect is very rapid but symptoms may return later.

Daily exercises help to alleviate the symptoms of carpal tunnel syndrome during pregnancy.

• Stand up and extend your arms forward by extending your wrists and fingers and giving a "stop" sign. Hold this position for a few seconds. Relax your arms and wrists and repeat the exercise 8-10 times.
• Bring your palms together in front of your chest, slowly lower your hands together towards your waist until you feel a stretch in your forearms.
• With a closed fist, bend both wrists downwards. Hold this position for 15 seconds.
• Extend your arm out in front of you with your palm facing upwards. Bend your wrist with your hand pointing towards the floor. Hold this position for 15 seconds and repeat 8 to 10 times.
• Bring your thumb and the rest of your fingers together. Place a rubber band around your thumb and fingers. Spread your fingers apart and then bring them together without allowing the rubber band to fall off.

All exercises are stretches of the wrist flexor muscles that can be repeated 8 to 10 times a day. Each exercise is held for about 15 seconds.

When the pain is too severe and unbearable and cannot be treated with the recommended exercises and other remedies or when the symptoms do not disappear within a few days after delivery, treatment will be surgical.

In most cases, carpal tunnel surgery is performed under local anaesthesia as an outpatient surgical procedure. During the surgery, a small incision of 3 to 4 centimetres is made in the palm of the hand, the transverse carpal ligament is cut and the nerve is released.

It is possible to perform an endoscopic operation by making one or two incisions of approximately 1 cm in the wrist and palm. After the surgery, it is advisable to keep the arm raised with the help of a handkerchief or sling to prevent swelling and bleeding. It is also important to flex the wrist but move the fingers a lot.