Many of my articles originate after patients ask me questions. I tend to think that if one person asks the question, there are others that have wondered about the same topic. Recently a couple of people have asked me about carpal tunnel syndrome in pregnant women.
Carpal Tunnel Syndrome (CTS) is a fairly common problem during pregnancy. In many cases it can arise during the third trimester, although it can occur earlier. The underlying issue is often related to swelling that occurs in the wrist areas. When the tissues in the area swell due to fluid changes during pregnancy, pressure can build up to cause irritation of the nerves that affect the hand.
Carpal Tunnel syndrome is a condition that can affect just one or both hands. The name carpal tunnel refers to the fact that wrist area is known anatomically as the carpal area. The Latin word for wrist is carpus, so that is where the name originated. The carpal tunnel is a bony archway in the wrist that provides a space for nerves, arteries, veins and tendons to pass through to the hand. Because the problem involves a nerve being pinched in this spot, it is called Carpal Tunnel Syndrome.
How does swelling cause a pinched nerve in the wrist? The carpal tunnel is a space that has a certain amount of room. The top of the tunnel consists of an archway of bones, so that is fixed. The underside is made by a very strong ligament, so that restricts that side. There is normally enough room for all of the anatomical parts named above to pass through the archway without issue. However, when there is fluid retention affecting the area, the pressure builds to the point that the nerve becomes compressed.
This nerve compression can result in several symptoms, including pain in the wrist area, tingling, numbness and weakness affecting the hand and middle fingers.
You may think that simply taking a drug to alleviate the symptoms would work. In some cases, it does. However, a pregnant woman should be thoughtful about any drugs taken during pregnancy and often doctors are reluctant to prescribe any drugs to their pregnant patients unnecessarily.
In some cases wearing a wrist splint can help. This reduces the amount of flexion in the wrist and can alleviate some stress on the joints and relieve symptoms to a degree. Most wrist braces commonly available are not ideal for CTS however, as they were designed to hold the wrist in what is known as a cock-up position, which in itself can be stressful for CTS. There are specially made CTS wrist braces that I have ordered for patients that work much better but these are not commonly available in retail stores.
Manual manipulation of the wrist joints can sometimes help reduce the joint fixations that may be adding to the problem.
In our clinic my go-to treatment for years for CTS has been acupuncture. This is especially well-suited for pregnant patients as there are no drug side effects. The treatment has shown itself to be very safe and effective in our experience.
What about other, non-pregnant, patients that have CTS? Acupuncture usually works great for these patients as well. In many cases it is not just fluid retention that is causing the problem. Muscles and tendons originating in the forearm are often involved, as well as the joints of the wrist area.
It may seem surprising but it is important to examine the neck of the patient with CTS. That is because the nerves that are affected in the wrist originate in the neck and may be being pinched or irritated there as well. There is such a thing as double-crush syndrome that means the nerve is being irritated in two places, specifically the neck and the wrist. For the most successful treatment it may be necessary to address both areas.
Carpal Tunnel Syndrome is a form of neuropathy that should always be taken seriously. It is best to determine the underlying cause of the problem and treat it rather than ignore it.