26 September, 2017
Carpal Tunnel Syndrome After Childbirth
Wrist pain is common in pregnancy and shortly after childbirth due to fluid retention, weight gain and ligament laxity. Carpal tunnel syndrome -- compression of the median nerve in the wrist -- frequently occurs during pregnancy. Although the symptoms typically resolve within a short period after childbirth, they sometimes continue after the baby is born.
The carpal tunnel is located in the base of the palm, just above the wrist. Nine tendons -- connected to muscles that bend the fingers and wrist -- and the median nerve travel through this tunnel. The tunnel is formed by small wrist bones and the transverse carpal ligament, which forms the "roof" of the tunnel.
The median nerve gives sensation to the thumb, index, middle and thumb side of the ring finger. It also powers several muscles that move the thumb. These muscles are located in the thenar eminence, the raised area of the palm just below the thumb. According to an article published in 2009 in "Punjab Journal of Orthopaedics," the incidence of carpal tunnel syndrome during pregnancy can be as high as 45 percent. The condition typically develops in the third trimester and often resolves with conservative treatment after childbirth.
Carpal tunnel syndrome causes pain, tingling and numbness in the area of the hand supplied by the median nerve. These symptoms worsen with prolonged forward or backward bending of the wrist. This can occur after childbirth when holding a baby during feeding. Repetitive gripping or movements of the wrist can also increase these symptoms.
Prolonged wrist bending is common while sleeping, and the symptoms of carpal tunnel syndrome are often the worst at night. Lifting and carrying an infant car seat by the handle can also worsen pain and tingling.
Modifying daily activities can help reduce symptoms of carpal tunnel syndrome. Straight positioning of the wrist reduces pressure on the median nerve. Whenever possible, this position should be maintained during daily tasks.
Infants spend a lot of time feeding, requiring wrist bending for long periods of time. A small pillow or rolled towel can be used to support the baby's head or placed underneath the mother's arms to avoid prolonged wrist bending. Breastfeeding can also be performed in a side-lying position. A small rolled towel or pillow can be placed behind the baby to support his back.
Larger muscles should be used to perform tasks to reduce pressure on the smaller muscles of the hand. For example, instead of gripping the handle to lift and carry an infant car seat, rest the handle on your forearm, close to the elbow joint.
Symptoms of carpal tunnel syndrome can significantly impact your quality of life, particularly for mothers with newborns. Treatment interventions are available to address these issues. Splinting the wrist in a straight position reduces pressure in the carpal tunnel. These splints are worn at night while sleeping and during the day as much as possible.
Pre-made splints can be purchased at many pharmacies. However, the internal metal bar is typically positioned in 20 to 30 degrees of extension -- or backward bending. You can adjust the splint to support a straight wrist position. Remove the bar and step on it or use a rubber hammer to straighten it. Reinsert the bar into the splint. Custom thermoplastic splints are made by occupational and physical therapists trained in hand therapy.
Hand therapy interventions, including ultrasound, massage, electrical stimulation and heat, are used to decrease pain and increase blood flow in the carpal tunnel. Tendon and nerve gliding exercises are prescribed to keep these structures moving smoothly through the carpal tunnel. A steroid injection may be administered by a doctor to decrease inflammation in the tunnel.
According to a study published in 2009 in the "Wisconsin Medical Journal," up to 49 percent of women diagnosed with carpal tunnel syndrome during pregnancy still had symptoms three years after childbirth. Carpal tunnel syndrome that does not resolve with medical treatment after childbirth may require surgical intervention. Surgery involves cutting the transverse carpal ligament to relieve pressure on the median nerve within the tunnel.
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