Pregnancy is an exciting time for all involved, however, musculoskeletal pain can be debilitating for mothers-to-be and new mothers alike. While low back pain is the most common musculoskeletal problem of pregnancy, conditions of the hand and wrist, including carpal tunnel syndrome, De Quervain’s tenosynovitis, and trigger finger are frequent causes of pain, disability, and stress during this time.
Dr. Tony Trenga is a fellowship-trained hand surgeon at Hand to Shoulder Specialists of Wisconsin here to answer some common questions related to hand and wrist problems of pregnancy and the post-partum period, to help you focus more on your new addition.
"With our first child, my wife suffered from pregnancy-related hand and wrist pain. This was very painful and frustrating to her when she already had her plate full caring for a newborn and learning to be a first-time mom. Luckily these problems are readily treatable."
What is carpal tunnel syndrome (CTS)?
Carpal tunnel syndrome is a condition where there is increased pressure on the median nerve as it passes through the wrist, leading to symptoms such as numbness, tingling, and weakness in the hand and fingers.
How common is carpal tunnel syndrome during pregnancy?
CTS is relatively common during pregnancy, affecting around 31-62% of pregnant women. It is the second most common musculoskeletal problem during pregnancy after low back pain. It typically occurs in the second and third trimesters when fluid retention and swelling are more pronounced. It can occur in one or both hands.
What causes carpal tunnel syndrome in pregnancy?
It’s believed to be due to pregnancy related fluid retention and swelling, which increase pressure on the median nerve in the wrist. Hormonal changes may also play a role. Patients with gestational diabetes may also be at increased risk of CTS during pregnancy.
What are the symptoms of carpal tunnel syndrome in pregnancy?
Symptoms include numbness, tingling (especially in the thumb, index, middle, and part of the ring finger), nocturnal wakening, pain that radiates up the arm, weakened grip strength, and difficulty holding objects.
How is carpal tunnel syndrome diagnosed during pregnancy?
Diagnosis is usually based on symptoms and physical examination. Nerve conduction studies (NCS), electromyography (EMG), or Ultrasound may be performed to confirm the diagnosis.
Can carpal tunnel syndrome harm the baby or pregnancy?
CTS itself does not pose a direct risk to the baby or pregnancy. However, it can cause discomfort and affect daily activities for the mother.
What are the treatment options for carpal tunnel syndrome in pregnancy?
- Conservative management: Resting the affected hand, avoiding repetitive movements, wearing a wrist splint at night, over-the-counter pain relievers like acetaminophen (Tylenol), and applying cold packs can help alleviate symptoms.
- Hand therapy: Gentle exercises and stretches can improve wrist flexibility and strength. Our certified hand therapists here at HSSWI can demonstrate these exercises and guide your treatment.
- Steroid injections: Corticosteroid injections have been shown to be safe and effective in treating CTS during pregnancy.
- Surgery: In patients whose symptoms do not resolve with bracing, injections, or therapy, and are severely limiting, surgery can be considered in the third trimester or post-partum. To minimize transfer to baby and breastmilk, this can be done entirely under local anesthesia (Wide-Awake Local Anesthesia with No Tourniquet – WALANT) without the use of narcotic pain medication.
Is corticosteroid injection during pregnancy safe to me and my baby?
Pregnancy is not a contraindication to local steroid injection. According to the American Academy of Orthopedic Surgeons (AAOS) Committee on Healthcare Safety steroid injection is safe in pregnancy and there is no evidence of local steroid injection causing adverse effects on fetal development. Because the steroid is injected locally, systemic absorption is small with minimal crossing the placenta and ultimately reaching the fetus. Several studies demonstrate the efficacy of steroid injection in pregnancy-related CTS.
Will carpal tunnel syndrome go away after pregnancy?
For many women, symptoms of CTS improve or resolve after childbirth, especially as fluid retention decreases. However, given the repetitive motion of the hand and wrist required to care for a newborn, symptoms may persist, and other conditions of the hand and wrist may occur, such as trigger finger and De Quervain’s Tenosynovitis or "Mommy Wrist."
Additionally, hormonal changes may result in ligament and joint laxity and exacerbate underlying arthritis.
What is “Mommy Wrist” (De Quervain’s Tenosynovitis)?
De Quervain's tenosynovitis is a condition that affects the tendons on the thumb side of the wrist. It involves inflammation of the tissue (tenosynovium) that surrounds two tendons that control movement of the thumb: the abductor pollicis longus and the extensor pollicis brevis. Swelling in the area causes constriction of these tendons within their sheath leading to painful motion of the wrist. The inflammation occurs from repetitive motion and positioning, such as holding a newborn.
How is De Quervain’s Tenosynovitis treated?
While rest is the key, we know that is not possible for new parents! Bracing, avoiding certain positions, and steroid injections can provide relief and are often curative.
When non-surgical treatment fails to relieve symptoms, surgical release of the sheath overlying the tendons of the thumb can be performed through a small incision. As with carpal tunnel release, this can be performed under local anesthetic and without narcotic pain medication. The procedure is relatively quick, and patients go home the same day.
Ultimately, hand and wrist pain should not take away from enjoying time with your new baby and family. Dr. Trenga and the rest of the surgeons at Hand to Shoulder Specialists of Wisconsin are parents and know how important this time is for you and your family. For assistance with any problem of the hand, wrist, elbow, or shoulder, call (414) 453-7418 or visit HSSWI.com to schedule an appointment today.
About Dr. Trenga:
Anthony P. Trenga, MD is a fellowship-trained hand surgeon specializing in all aspects of the hand, shoulder, and elbow. Originally from the east coast, Dr. Trenga, his wife, and two children have made Wisconsin home for more than half a decade. Dr. Trenga sees patients throughout the greater Milwaukee area.
About Hand to Shoulder Specialists of Wisconsin:
HSSWI, formerly Hand Surgery Ltd, is dedicated to treating all aspects of the upper extremity in Southeastern Wisconsin. All surgeons at HSSWI are fellowship-trained in hand and upper extremity surgery to provide comprehensive subspecialist care unique to the region.
References:
- Westbrooks, T; Walker, M; O’Shaughnessy MA. Are Steroid Injections a Safe Treatment for CTS during Pregnancy? AAOS Now, July 2023
- American College of Obstetricians and Gynecologists (ACOG). Nonobstetric Surgery During Pregnancy (Joint with the American Society of Anesthesiologists) (Obstet Gynecol 2019;133:e285–6)
- American College of Obstetricians and Gynecologists (ACOG). Carpal Tunnel Syndrome During Pregnancy. Accessed at acog.org
- American Academy of Orthopaedic Surgeons (AAOS). Carpal Tunnel Syndrome. Accessed at orthoinfo.aaos.org
- UpToDate. Carpal tunnel syndrome in pregnancy. Accessed at uptodate.com
- Oliveira, G.A., Bernardes, J.M., Santos, E.d. et al. Carpal tunnel syndrome during the third trimester of pregnancy: prevalence and risk factors. Arch Gynecol Obstet 300, 623–631 (2019). https://doi.org/10.1007/s00404-019-05233-6
- Filippini, C., Saran, S. & Chari, B. Musculoskeletal steroid injections in pregnancy: a review. Skeletal Radiol 52, 1465–1473 (2023). https://doi.org/10.1007/s00256-023-04320-9