As a pelvic health and pregnancy physiotherapist, I most often see women who are experiencing pain around their pelvis and lower back during pregnancy - which is super common as those areas see a great deal of stress, resulting from the loads of a growing baby.
However, there is another condition that can be quite common during pregnancy that particularly affects the hands and wrists! Carpal Tunnel Syndrome and the associated pain many Mamas have to deal with when expecting a new bub can be very restrictive and difficult to manage.
In this instance we're so grateful to have an expert guest blog post from Hand Therapy Physiotherapist Sophie Halsall-McLennan of Fresh Start Physio in Victoria to shed some light on this common and important condition. Take it away Sophie!
What Is Carpal Tunnel?
Carpal tunnel syndrome is a common condition that occurs when there is too much pressure on the median nerve in the wrist. It may include symptoms of tingling, numbness and pain in the wrists, hands and fingers.
Carpal tunnel syndrome is also very common during and after pregnancy. In fact, one in four pregnant women may experience carpal tunnel syndrome, most often during the second or third trimester and in some cases several days after the baby’s birth. Development of carpal tunnel during a pregnancy or post-partum also increases the chances of it to recur in future pregnancies.
The term “carpal tunnel” refers to a small tunnel inside the forearm at the level of the wrist. The tunnel is bordered by carpal bones at the top of the tunnel and the transverse carpal ligament on the underside. Tendons, blood vessels and the median nerve all occupy this small space and each structure contributes to the function of the hands and wrist.
What Happens During Pregnancy
When pregnant, your blood volume increases by up to 50 percent in order to nourish the uterus, placenta and baby. This extra volume of blood and retention of extra body fluid (oedema) in wrist tissue can increase the pressure within the carpal tunnel and therefore impact upon the health and function on your hand and wrist nerves.
The build-up of oedema in wrist tissue and the carpal tunnel during pregnancy can compress the median nerve which runs to your hand and fingers, leading to carpal tunnel syndrome. The symptoms may be exacerbated if repetitive hand and wrist movements occur for a significant amount of time, for example typing for many hours at work.
Other Causes
There are other factors that may increase the likelihood of developing carpal tunnel syndrome during pregnancy. One of these includes obesity. If the pregnancy leads to gaining even more than average weight due to expecting twins or a particularly heavy baby, it can add significant weight and fluid build-up. Being fitted for a high-quality, supportive maternity bra can help to reduce the pressure on your rib cage and breastbone, which in turn reduces the pressure on the nerves that supply the shoulder and arms, thereby reducing symptoms of nerve compression.
Symptoms
The primary symptoms of Carpal Tunnel syndrome may include sensations of tingling, pain or numbness, and weakness, resulting in difficulty gripping objects and moving fingers. Pain, pins and needles and weakness is often concentrated in the thumb, index and middle finger and half of the ring finger as well as the wrist itself. Symptoms may be worsen during the night and are heavily influenced by your sleeping position.
Diagnosis
Carpal tunnel is diagnosed by the aforementioned symptoms, in conjunction with a number of non-invasive tests and a physical assessment done by a Physiotherapist. Depending on symptoms and circumstance, an ultrasound or other imaging may be advised in order to check for irregularities in the wrist. Unclear symptoms may require other investigations in order to determine precisely where the origin of symptoms is.
Treatment
Treatment for carpal tunnel may include using a wrist splint to enable the wrist to rest, thereby reducing the swelling in the tunnel. A splint will maintain the wrist in the best position to minimise the pressure within the tunnel. Your Physiotherapist may also use manual treatments to reduce inflammation and swelling, improve movements in the hand and wrist and to maintain the strength of the hand and wrist.
What You Can Do
Home exercises to help alleviate symptoms including: icing the hand and wrist, elevating the hand and wrist and gently exercising to try to restore some flexibility and strength may also be incorporated in the management for Carpal Tunnel Syndrome. If these methods are not effective, steroid injection of cortisone, diuretics and surgery may be considered in consultation with a Hand Surgeon.
In most cases, symptoms of carpal tunnel syndrome will subside following delivery of the baby, as the fluid build-up during pregnancy lessens back to regular levels. However, in some cases this drawdown of symptoms after pregnancy can take up to three months, so treatment, if the pain and symptoms is severe, is advisable. It should be noted that having carpal tunnel syndrome during pregnancy will not harm your baby in any way.
Further discussion with your Physiotherapist on how to manage symptoms and adapt your household and work activities to work around the condition and alleviate its symptoms can be very helpful.
About The Author: Sophie Halsall-McLennan is the owner of Fresh Start Physiotherapy. She is a hand therapist working in the Geelong region and has a Bachelor of Physiotherapy from Charles Sturt Physiotherapy, over 12 years of clinical experience as a Physiotherapist and is registered with AHPRA. She is also a Lecturer at Deakin University.
