Ever wonder why your hands feel painful and numb in the middle of the night or in the early morning, disturbing the peaceful sleep you so desperately need? You may be suffering from Carpal Tunnel Syndrome (CTS). Up to one in 4 pregnant women develop carpal tunnel syndrome during pregnancy or after delivery.
What is Carpal Tunnel Syndrome (CTS)?
CTS is due to compression of the median nerve at the wrist as it passes from the forearm into the hand.
The median nerve is a major nerve that provides sensation to the thumb, index, middle and half of the ring fingers and controls the muscles at the base of the thumb.
At the wrist, the median nerve passes through a tunnel, surrounded by bones on 3 sides and is covered over by a thick unyielding fibrous sheet called the flexor retinaculum.
During pregnancy, as the body swells from water retention, the median nerve becomes compressed in this enclosed space. After delivery, as the body readjusts back to the pre-pregnant state, the retained water is lost and symptoms of CTS will improve.
However breastfeeding can prolong the compression or cause CTS symptoms in mothers who did not have them during pregnancy. This is because of hormonal changes brought on by breastfeeding.
How do I know if I have CTS?
Symptoms of CTS usually occur in the later half of pregnancy, when water retention is at its maximum. Less commonly, it can start during the early part of pregnancy or with the onset of breastfeeding.
Numbness, pain and tingling may occur in one or both hands. This often happens in the early morning, waking you up and preventing you from getting enough sleep. Shaking the hands may temporarily relieve the numbness.
The pain may appear to radiate from the hand, up the elbow and to the shoulder. In severe cases, symptoms can occur throughout the day, leading to clumsiness with the hands, weakness and dropping things.
What can I do about it?
Your doctor will be able to assess the severity of the condition and exclude other causes of your symptoms. Wearing a wrist splint or brace when you sleep can be extremely helpful. This holds the wrist in a position where the carpal tunnel is at its maximum size, thereby decreasing compression on the median nerve. Vitamin B6 supplements may be helpful in some patients.
It is important to avoid repetitive hand movements at work or in the house that may precipitate the symptoms. Similarly, when working on the keyboard, it is important to avoid excessive bending of the wrist and to take frequent breaks away, from the keyboard.
With these measures, most patients with CTS symptoms will improve and recover after the birth of the baby. However it may take as long as one year to do so. Majority of patients with CTS that developed during pregnancy do not need surgery.
Occasionally when symptoms are severe, when they do not improve with treatment as described above or when symptoms start in the early part of pregnancy, surgery may be required to prevent further damage to the nerve.
Surgery for CTS
This is usually done through a longitudinal incision in the base of the palm to release the tough flexor retinaculum. Newer techniques use the endoscope to cut the flexor retinaculum through a small incision in the wrist, along a natural skin crease.
The advantage of this endoscopic method is that the incision is smaller and located away from the thick sensitive palmar skin, making the resulting scar less prominent and less painful. There is less downtime as patients get back the use of their hands earlier. Better patient satisfaction has been reported both in short and long term studies done.
Hand pain and numbness due to CTS in pregnancy is common. It can be easily treated and will resolve after delivery; although some cases may require surgery. Get treated early. Don’t suffer in silence, and do not lose sleep over it!
