Carpal Tunnel Syndrome In Pregnancy

The hollow space formed by the carpal bones of the wrist below and the fascia (thin shiny envelope covering the muscle tendons) above is known as the carpal tunnel. These bones enclose the median nerve, the ulnar nerve and the flexor tendons of the forearm.

What is Carpal Tunnel Syndrome (CTS)?

The median nerve of the hand is responsible for the sensory supply of the lateral half of your palm (flexor aspect), while it’s motor innervation controls most of the flexor muscles of the forearm. Conditions like inflammation, fluid retention or trauma to the arm can lead to increased pressure within the carpal tunnel. This may, in turn, compress the median nerve which can lead to sensory or motor symptoms in the hand, including tingling, numbness, pain and weakness of grip. This group of symptoms is collectively known as the carpal tunnel syndrome.

What Causes Carpal Tunnel Syndrome in Pregnant Women?

Pregnancy: This is a state where there is excessive fluid retention and hence resultant weight gain. Most of the fluid accumulates in the extra-vascular spaces (outside the blood vessels) like the peritoneum (abdominal free space), joint cavities or loose subcutaneous tissues. The wrist space or the carpal tunnel is one such small space where fluid accumulates easily. This space encases important structures like the median nerve, flexor tendons of the hand, ulnar nerve, etc. The median nerve gets easily compressed whenever there is compression of the space. Fluid retention is common in the second trimester of pregnancy, and hence carpal tunnel syndrome is more common in mid-pregnancy.
Inflammatory conditions: Inflammation, in general, manifests with pain, swelling, and redness. Inflammation-causing carpal tunnel syndrome can be local due to trauma or joint pathology. It may also be associated with various systemic inflammatory disorders.

The following systemic disorders can be the causes of carpal tunnel syndrome in pregnancy:

Diabetes Mellitus

It is the most common autoimmune endocrine disorder associated with weight gain and associated fluid retention which can lead to carpal tunnel syndrome as one of its local complications besides affecting the eyes and the kidney. Diabetes in a pregnant woman doubles the chances of carpal tunnel syndrome owing to the cumulative retention of fluid.

Hypothyroidism

This is also a state of reduced metabolism and hence excessive weight gain due to fluid retention.

Hypertension

Excessive blood pressure leads to leakage of fluid in the third space or out of the blood vessels. This fluid then accumulates in the loose cutaneous tissues.

Autoimmune disorders

Some disorders like, Rheumatoid arthritis, Gouty arthritis, and Systemic lupus erythematosus which cause joint swellings and effusions.

Local trauma or fractures of the bones forming the wrist joint, like Colle’s fracture, which commonly occur in postmenopausal women, can lead to local inflammation and result in carpal tunnel syndrome.

Excessive joint movement

Carpal tunnel syndrome is worsened by repeated and excessive joint movements. Constant use of the joint hampers the resolution of inflammation and hence prevents healing. Professions like sports including tennis and badminton, musicians playing guitars or pianos, fine artists, hardware tools operators, etc. are at a higher risk due to excessive joint movement at the wrist.

Sign & Symptoms

Symptoms of carpal tunnel syndrome can easily be recognised by the patient herself, as the compression of median nerve causes intense pain, tingling in the region of hand supplied and numbness.

Besides pain and tingling, the symptoms of carpal tunnel syndrome may be broadly divided into motor and sensory symptoms for simpler understanding.

Motor symptoms

• These include the inability to make a fist, hold an object in the hand, or clumsiness of the hand.
• Difficulty in doing daily chores, like brushing teeth, buttoning and unbuttoning of clothes, holding a pen, etc.
• Difficulty in doing fine activities, like typing, sewing, doing artwork, etc.

Sensory symptoms

• Loss of sensation in the region of the palm which is supplied by the median nerve. The median nerve supplies the skin of the lateral three-fourths of the flexor aspect of palm.
• Loss of skin creases and excessive susceptibility to burns and trivial traumas due to the reduced sensation.

Who is at Risk of CTS?

Women are more prone to carpal tunnel syndrome than men. Pregnancy further predisposes women for this condition. Carpal tunnel syndrome is also more commonly diagnosed in patients between their thirties and sixties.
It is also more common with certain lifestyle factors like, high-fat diet and obesity, sedentary habits, cigarette smoking, alcohol consumption, jobs which require prolonged hours of immobilisation and repeated and excessive joint movements.
People suffering from chronic diseases like diabetes mellitus, hypertension, thyroid disorders and autoimmune diseases including arthritis are at increased risk for carpal tunnel syndrome.

Diagnosis of Carpal Tunnel Syndrome

A clinical diagnosis can be ascertained based on a detailed history of symptoms, elaborate physical examinations, laboratory tests and nerve conduction studies or NCS.
Examination of all the joints of upper limbs including the shoulders, elbows, and wrists will determine and rule out any other cause of nerve compression at various levels in the course of the nerve. Any local swelling, redness or deformity can be observed, while pain on touching indicates tenderness. Tests for sensation over the skin of palm and motor examination including object holding test can be useful for the diagnosis.
NCS or Nerve conduction studies definitively tests carpal tunnel syndrome in pregnancy. It measures the velocity and amplitude of an electrically transmitted impulse through the nerve being tested. A delay in the conduction indicates nerve damage and hints towards carpal tunnel syndrome in the case of median nerve of hand.

A few natural remedies for carpal tunnel syndrome during pregnancy include:

Herbal therapy

Applying cabbage leaves over the affected joint is believed to reduce inflammation.

Drinking water

Adequate hydration, following a balanced diet with low uric acid is an effective sure.

Massage

Regular exercise with intermittent rest and massage of the wrist while at work helps relieve symptoms.

Yoga

Yoga can be of significant help in relieving the pain and is a good lifestyle habit.

Acupressure

Applying controlled pressure on certain spots over the palm can significantly reduce the pain and inflammation.

Treatment of Carpal Tunnel syndrome in Pregnancy

Medical treatments are mostly conservative and include the following options:

• Support

Splinting of the affected wrist during night time for about three weeks.

• Non Steroidal Anti-inflammatory Drugs (NSAIDS)

Analgesics like diclofenac and ibuprofen, significantly reduce the inflammation and hence relieve the pain. Diuretics: Injectable or oral diuretics reduce the fluid and swelling to provide symptomatic benefit.

• Anti Convulsants

Gabapentin and Pregabalin are effective in reducing the pain.

• Local Steroid Injection

Injecting a steroid reduces the inflammation and has significant benefits in cases not relieved by NSAIDs.

• Hormonal injections

Local Progesterone injection.

Surgical options are considered for patients who have severe CTS disease and do not respond to medical management. Surgically releasing the transverse ligament of the wrist, has proven to be effective in up to 85% cases. The procedure has a low rate of complications and is increasingly being practised.
Contemporary therapies are also practised as an add-on or stand-alone therapy in a few cases. These include:

• Yoga:

Yoga can be of significant help in relieving the pain and is a good lifestyle habit.

• Acupressure

Applying controlled pressure on certain spots over the palm can significantly reduce the pain and inflammation.

Pain Relief for Carpal Tunnel Syndrome during Pregnancy

The self-help and natural remedies for carpal tunnel syndrome listed below can help relieve the pain:

• Herbal therapy

Applying cabbage leaves over the affected joint is believed to reduce inflammation.

• Hydration

Adequate hydration while preventing over-hydration.

• A Healthy Diet

Following a balanced diet rich in Vitamin A, B complex and Vitamin C and low uric acid.

• Exercise

Regular exercise with intermittent rest and massage of the wrist while at work.

• Hot Compress

Application of hot compresses over the inflamed wrist area can help relieve the pain.

• Sea Cord Oil

Drinking Sea cord oil is beneficial for joints and cartilages

Carpal tunnel syndrome during pregnancy can be a significantly distressing experience. Prompt recognition of symptoms, timely workup and diagnosis can help treat the condition. Initial non-pharmacological measures involve physiotherapy, yoga and lifestyle changes including diet and moderate daily exercising. This can lead to symptom reduction and general well being. Although rarely reported, wrongly diagnosed or inadequately treated carpal tunnel syndrome may over time lead to permanent neuritis damage resulting in a handicap and ultimately loss of hand function.