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If you are experiencing tingling, numbness, and painful hands while pregnant, it may be caused by carpal tunnel syndrome.
26 November 2020
| Last updated on 7 December 2020
Pregnancy is a crucial experience in a woman’s lifetime, usually cherished in her memory as one of the highlights of her whole existence.
Yet, it can also be a very challenging event. A woman’s body has to undergo many major changes to provide a suitable environment for the new life growing inside her.
Each woman lives pregnancy in her own personal way and each pregnancy may be different for the same woman, both emotionally and physically. Some of the physical changes might eventually impact on her wellbeing and result uncomfortable.
A frequent complaint during pregnancy is the onset of “pins and needles” in the hands, related to the onset of a medical condition known as carpal tunnel syndrome.
What is Carpal Tunnel Syndrome?
Carpal Tunnel Syndrome (CTS) is due to compression of a nerve (the median nerve) inside the carpal tunnel, a narrow passageway located between the wrist and the palmar hand that is formed by small bones and a strong band of tissue called 'transverse carpal ligament'.
The median nerve is one of the main nerves of the hand and provides sensitivity and movement. It runs in the carpal tunnel with other structures (tendons and blood vessels) and if it compressed or squashed in any way, it causes the onset of carpal tunnel syndrome.
How frequent is Carpal Tunnel Syndrome in pregnancy?
Carpal Tunnel Syndrome is a frequent medical condition in the general population, mostly affecting ladies and especially manual workers. The onset of symptoms related to CTS is a very frequent occurrence during pregnancy, it has been estimated to affect up to 60% of moms-to-be.
Expecting women that use their hands a lot (for instance those who spend long hours working at computers), are particularly predisposed to develop symptoms consistent with CTS.
What causes Carpal Tunnel Syndrome?
Pregnancy-related hormonal changes cause a build-up of fluid ('oedema') in soft tissues.
Pregnant ladies often notice their hands have become swollen; fluid collection inside the narrow carpal tunnel increases the pressure on the median nerve, triggering the onset of symptoms.
What symptoms are consistent with Carpal Tunnel Syndrome?
Symptoms usually arise around the third semester yet CTS can also crop up as early as the first trimester.
CTS can affect one hand only (typically the dominant hand) but it is usually bilateral. The onset of CTS clinically manifests with:
- Numbness and tingling in the fingers, hands and wrists.
- Pain or throbbing in the fingers, wrists or forearm.
- Swollen and hot fingers.
- Difficulty gripping objects and performing fiddly tasks.
Although the whole hand may be affected, feelings of pain, numbness, and tingling are particularly severe on the fingertips, especially along the thumb, index and middle finger.
Symptoms typically worsen at night; this is because the fluids that accumulate in the lower part of the body during the day are redistributed to the extremities when lying down.
How to confirm that symptoms are due to Carpal Tunnel Syndrome?
Although in recent times, googling symptoms has become very common, assessment by a physician should always be preferred.
'Pins and needles’ are rather common symptoms that may be consistent with several medical conditions. The opinion of an expert (preferably a doctor subspecialized in peripheral nerve pathology) is certainly helpful.
Clinical assessment may be followed by investigations to confirm the clinical suspicion; CTS is detected by EMG/NCS, a test that measures the speed of electrical signals transmission along the nerves and records the electrical activity in muscles.
Wrist ultrasound is also commonly used to reveal the compression on the median nerve inside the carpal tunnel.
What can be done to relieve symptoms?
After diagnosis confirmation, the following techniques may prove useful to reduce the severity of symptoms:
- Rest: overuse of hands predisposes to worsen symptoms. Avoiding non-essential activities whenever possible usually proves beneficial. Trying to rest hands and wrists on a pillow as often as possible is usually helpful as well.
- Apply ice: Another method can be to alternate placing the painful hands in one basin with cold water and then one containing warm water for one minute each. Repeating this alternation up to 5 minutes a few times per day (3 to 4) can be beneficial.
- Elevation: rolling up a towel or folding a pillow and leaning the hand on it so to keep it elevated during the night rest reduces the swelling.
- Wearing nocturnal splints: the use of splints during night rest prevents bending the wrists.
Pictured: nocturnal splints
- Medications: medical treatment is focused on reducing soft-tissue oedema, the physician can prescribe some medications based on the general assessment of the course of pregnancy.
- Physiotherapy: several stretching and gliding exercises can be advised by physiotherapists and they usually prove extremely beneficial in favoring the subsidence of symptoms. Performing series of exercises a few times a day at home is usually recommended.
What happens after the baby is born?
In most cases, symptoms tend to progressively subside during the first weeks after delivery. However, pain, numbness, and tingling in the hands may be persistent during breastfeeding.
Discontinuing breastfeeding is usually followed by the resolution of symptoms.
Getting pregnant again may trigger the recurrence of pain, numbness, and tingling in the hands, often with earlier onset in comparison with the first pregnancy.
Several pregnancies (especially when close) and prolonged lactation may eventually predispose to persistent symptoms. In these cases, the compression on the nerve may become ongoing and might result in nerve damage.
Progressive sensory loss and weak handgrip are clear signs of nerve damage and at this stage is important to promptly seek medical advice. Long-dating ongoing compression on the nerve may be responsible for irreversible functional damage on the nerve.
In many women who experienced temporary carpal tunnel syndrome during pregnancy and lactation with spontaneous resolution, menopause can trigger the recurrence of pain and numbness on the hands.
Compiled by Dr. Debora Garozzo
Dr. Debora Garozzo
Consultant Neurosurgery
Mediclinic Parkview Hospital
