Carpal Tunnel Syndrome (CTS)
Carpal Tunnel Syndrome (CTS) is a relatively common condition that causes pain, numbness and a burning or tingling sensation in the hand and fingers. Symptoms of CTS can range from mild to severe.
In cases of CTS, the space inside the tunnel is made smaller by the increased tissue pressure and a build-up of fluid in the tissue (oedema). This places pressure on the median nerve. The pressure is increased further when the wrist and fingers are bent (flexion). Compression of the median nerve causes the symptoms of pain and numbness.
Women often experience their first episode with Carpal Tunnel Syndrome when they are pregnant due to hormonal changes and water retention which are common during pregnancy. Although the nagging Carpal Tunnel Symptoms can appear at any time, they usually occur during the second half of pregnancy. Often a pregnant woman will crave sodium rich or salty foods during pregnancy which can exacerbate water retention. Sometimes Carpal Tunnel Symptoms go into remission after pregnancy and other times the pain and numbness continues for months or even years.
The most common symptoms are hand pain, hand numbness, tingling sensations in the fingers, hand and thumbs and pain shooting up the forearm. It can even translate to shoulder and neck pain following the nerve path back to the brain. Often these symptoms are most intense at night and result in routine sleep disturbance. The last thing an expecting mother needs is another cause of routine sleep interruption. Restful sleep is an important element of good health but it is especially important for an expectant mother and the developing baby.
It is ironic that just as a woman needs her hands the most to prepare for the birth and care for a new born child, her hand use is often inhibited by hand pain and numbness of the fingers and thumb associated with Carpal Tunnel Syndrome. Up to Twenty percent of pregnant women will experience this debilitating syndrome at some point during their pregnancy.
Diagnosis of carpal tunnel syndrome is usually clinical supplemented by nerve conduction tests.
CTS in pregnant women often gets better with three months of the baby being born. However, in some women, symptoms can continue for over a year.
Some of the conventional approaches to treating Carpal Tunnel Syndrome are just not viable options during pregnancy. What is needed is a conservative, non-invasive treatment that relieves the pain, improves restful sleep, allows a return to full activity and does not result in any systemic interference with the developing baby.
Exposing a fetus to intensive use of systemic oral pain medication is not a good idea for an expecting mother and localized steroid injections may be necessary if splints fail.
If CTS is recognised early it can usually be treated. However, if it is left untreated it can lead to chronic weakness of the hand, numbness and nerve damage.
A removable wrist splint (brace) is often advised as a first active treatment. The aim of the splint is to keep the wrist at a neutral angle without applying any force over the carpal tunnel so as to rest the nerve. This may cure the problem if used for a few weeks. A splint may be a bit cumbersome to use during the daytime. However, it is common to wear a splint just at night, which is often sufficient to ease symptoms.
Over the years, a wide range of other treatments have been advocated. For example, diuretics (water tablets), physiotherapy, vitamin B6, manipulation of the wrist, and treatment with ultrasound. None of these treatments has good research evidence to support its use and so they are not commonly advised.
If all methods of treatment fail then a small operation under local anaesthetic can cut the ligament over the front of the wrist and ease the pressure in the carpal tunnel. This usually cures the problem.