Understanding Pregnancy-Related Carpal Tunnel Syndrome

The carpal tunnel is a narrow passageway in the wrist through which the median nerve travels to supply sensation to the thumb, index finger, middle finger, and part of the ring finger. Because the tunnel is rigid and space is limited, any swelling within it compresses the median nerve, and that compression is what produces the discomfort of PRCTS.

During pregnancy, fluid retention is the primary driver. As excess fluid accumulates in the tissues of the carpal tunnel, pressure on the median nerve builds, triggering the burning, tingling, and numbness that are characteristics of PRCTS.

Symptoms most often emerge in the second or third trimester, when fluid retention peaks, and both hands are typically affected. Symptoms are often worse at night, because lying flat allows fluid to redistribute and pool in the arms and hands. In addition, many people sleep with their wrists bent, which further narrows the tunnel and aggravates symptoms.

By some estimates, up to 70% of pregnant women will experience PRCTS. The symptoms of PRCTS often cause more than discomfort, they actively disrupt daily routines. The physical demands of caring for a newborn can exacerbate PRCTS or even trigger new postpartum cases, since many of the tasks surrounding caring for an infant involve lots of repetitive gripping and lifting with bent wrists.

Daily Impact and Limitations

PRCTS is associated with some functional limitations, including the following:

• Loss of Grip Strength: Pregnant women often experience weakness in their hands, which can make holding a mug, turning doorknobs, or buttoning clothes frustratingly difficult.
• Disrupted Sleep: Waking up repeatedly with numb or painful hands compounds the exhaustion that accompanies late-stage pregnancy and life with a newborn.
• Fine Motor Challenges: Tasks requiring precision, like fastening a baby’s diaper, manipulating small snaps on onesies, or opening safety seals on formula bottles, become painful and clumsy.

The Postpartum Shift

While PRCTS often resolves on its own within a few weeks of delivery, the condition occasionally develops or persists after birth. One driver of postpartum CTS is the repetitive motions that are required in early motherhood, lifting an infant out of a crib, holding a baby’s head during breastfeeding, which put a great deal of stress on the wrists, exacerbating median nerve inflammation.

PRCTS can affect any expectant or new mother, but there are some risk factors that increase the likelihood of developing symptoms, including:

• Pre-existing Conditions: Chronic health issues like diabetes, high blood pressure, or thyroid disorders have a higher risk for PRCTS. Since these conditions affect fluid balance, circulation, and nerve sensitivity, the median nerve is more vulnerable to compression.
• Weight and Fluid Dynamics: Women who gain more weight during pregnancy than medically recommended have higher fluid retention rates and increased overall pressure on their tissues, including the hands and wrists. Carrying multiples (twins or triplets) also increases the risk for PRCTS.
• Repetitive Strain: Jobs or hobbies that involve repetitive hand and wrist movements increase your risk for PRCTS, and when pregnancy-related hormonal changes and fluid retention are added to the picture, the risk is elevated.

The hormonal shifts and fluid retention associated with pregnancy can’t be changed, but there are steps you can take to protect yourself from PRCTS. Some tips to try include the following:

• Ergonomic Adjustments: If you’re frequently in front of your computer, make sure your workstation is set up so it supports neutral alignment in your wrists. In other words, your wrists should be straight, not bent up or down, when you’re typing. An ergonomic keyboard or wrist rest is often helpful. Make sure you take frequent breaks to stretch your fingers and rotate your wrists.
• Body Mechanics in Infant Care: A simple strategy to protect your wrists when you pick up your baby is to slide your hands under the baby and lift using your forearm muscles and flat palms. When you use just your thumbs and fingers to lift your baby, it puts intense strain on your wrists. A dedicated breastfeeding pillow or sling gives your baby support during nursing without having to hold your wrist in a flexed position for prolonged periods.
• Managing Fluid Retention: It may seem counterintuitive, but drinking plenty of water helps prevent fluid retention because it prompts your body to flush out excess fluids. Limit sodium intake, since it promotes fluid retention. When you’re resting, put pillows under your wrists to keep them slightly elevated to encourage fluid to drain away from the carpal tunnel.

In most cases, conservative PRCTS treatment can make a meaningful difference for women who are experiencing symptoms. These treatments are effective and safe for pregnant and breastfeeding mothers and their babies. The most common PRCTS treatments are:

• Splinting and Bracing: A rigid wrist splint that keeps the wrists in a neutral position is one of the most effective treatments for PRCTS. The splints should be worn overnight, since many people curl their wrists inward while they sleep. In addition, wearing them when you do repetitive tasks can bring relief.
• Physical Therapy and Exercises: Gentle exercises for the hands and wrists improve fluid movement and nerve health in the carpal tunnel. “Nerve gliding” is a technique that helps the median nerve move more smoothly in the carpal tunnel passage. A physical therapist who’s familiar with PRCTS can create a tailored plan for you and teach you how to do the exercises correctly.
• Temperature Therapy: Applying ice packs to the wrists for 10-15 minutes can reduce pain and inflammation. Some mothers find contrast baths, alternating between hot and cold water baths, help stimulate circulation and reduce localized swelling.

If conservative treatments don’t provide enough relief, you may want to discuss medical interventions with your doctor. Women who are pregnant or nursing should consult their doctor before taking any medications, including over-the-counter anti-inflammatory drugs like ibuprofen. In severe PRCTS cases, a corticosteroid injection into the wrist can bring rapid relief. PRCTS typically resolves quickly after birth, and surgical remedies are rarely necessary.

New and expectant mothers are doing some of the most important work of their lives, and they deserve expert care. If numbness, tingling, or pain is making motherhood harder than it should be, reach out to the experts at The Hand and Wrist Institute. Dr. Knight and his medical team have provided orthopedic care to the Dallas-Fort Worth area for over 25 years, and his team has extensive expertise in pregnancy-related carpal tunnel syndrome.