Carpal Tunnel

My baby is now three months old but the carpal tunnel syndrome I developed during the pregnancy is still with me. My right thumb usually bends; my left thumb usually doesn't. The flexibility of each varies daily and throughout the day. When/Can I expect this problem to resolve itself?

Sue

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ABOUT THE EXPERT

Peg Plumbo CNM

Peg Plumbo has been a certified nurse-midwife (CNM) since 1976. She has assisted at over 1,000 births and currently teaches in the... Read more

Dear Sue,

This happens to be a topic which has been reviewed a great deal in the literature so I will pass on some abstracts to you.

It is felt that carpal tunnel is caused by nerve compression caused by water retention and traction on the nerve due to shifting of the shoulders to compensate for increased back curvature in later pregnancy. It is more common in the second and third trimesters and usually persists into the postpartum period. Although some relief is usually gained after the birth, it often takes up to 1-2 years for complete resolution. If symptoms still persist 6 mo to 1 year postpartum, splinting should be considered and even surgical intervention should not be ruled out.

I hope you find these abstracts useful and I wish you a quick resolution of this condition. Peg


Authors
Seror P.
Title
\[Carpal tunnel syndrome in pregnancy\]. \[French\]
Source
Journal de Gynecologie, Obstetrique et Biologie de la Reproduction. 26(2):148-53, 1997.
Abstract
Analysis of 20 patients with 34 carpal tunnel syndromes (CTS) showed that CTS in pregnancy occurs generally between 30 and 40 years of age in both primiparous (n = 7) and multiparous (n = 13) women. The syndrome usually is most bothersome during the third trimester of pregnancy (n = 10) or during puerperium (n = 7). Clinically, CTS in pregnancy is very different from idiopathic CTS. Paresthesia frequently occurs during the daytime or is permanent and usually more troublesome than phenomena occurring at night. The Weber and Semmes Weinstein test, an objective measurement of hypoesthesia, is often positive. The electrophysiological findings are more serious and are different from those observed in idiopathic CTS. Mean nerve conduction velocity in the median nerve measured at the wrist is comparable in the two forms, but the frequency of neurogenic pattern is higher in pregnancy CTS. Conduction blocks are also much more frequent and concern motor (18%) or sensory (44%) conduction. These conduction blocks result from acute compression of the nerve due to hormone-dependent tenosynovitis. Infiltrations are effective in 85% of the cases, but in some forms with very serious axonal loss, surgical release is justified.

Authors
Stahl S. Blumenfeld Z. Yarnitsky D.
Title
Carpal tunnel syndrome in pregnancy: indications for early surgery.
Source
Journal of the Neurological Sciences. 136(1-2):182-4, 1996 Mar.
Abstract
The incidence of carpal tunnel syndrome is increased during pregnancy. The common conventional therapeutic approach is conservative, as symptoms usually abate after delivery. We describe our experience with 65 hands (50 patients), who were treated initially by a conservative approach and later, when required, surgically. We found that all patients who (i) had either started having CTS symptoms during the first two trimesters or had previous history of CTS symptoms; and (ii) had both a positive Phalen test within less than 30 seconds and abnormal two point discrimination at the finger tips ( > 6 mm), were eventually operated upon, either during or after pregnancy, as conservative measures failed. We therefore recommend consideration of an early surgical approach in patients fulfilling these criteria.
Authors
Courts RB.
Title
Splinting for symptoms of carpal tunnel syndrome during pregnancy.
Source
Journal of Hand Therapy. 8(1):31-4, 1995 Jan-Mar.
Abstract
OBJECTIVE: To determine whether splints are effective in decreasing symptoms of carpal tunnel syndrome during pregnancy.

METHODS: Case series at a military hospital of 82 pregnant women who had symptoms of carpal tunnel syndrome (135 hands). The author compared the ratings of eight subjective symptoms (tingling, numbness, pain, weakness, wakes you up, drops things, swelling, and stiffness) and grip (Jamar) and pinch (two-point, three-jaw, and key) strengths at the time of referral and 1 week after splinting (polyform volar splint with the wrist in 10 to 15 degrees of extension). Forty-eight women (82 hands) returned 1 month postpartum for reassessment. Grip and pinch strengths of an additional 26 women who had not had problems with their hands during pregnancy were measured 1 month postpartum.

RESULTS: One week after splinting, there was an average increase of 5.4 pounds in grip strength and over 1 pound in each type of pinch strength (p < 0.0001). There was a decrease in each of the eight symptoms (range, -0.9 to -1.6; scale of 5). At 1 month postpartum, symptoms had resolved completely for 76% of the subjects (weakness had resolved for 76% and wakes you up for 93%). Strength was improved, but was not normal. However, the women who had not had hand problems during pregnancy did have normal strengths.

CONCLUSIONS: Splinting is a noninvasive method for helping to decrease the uncomfortable symptoms of carpal tunnel syndrome during pregnancy.


Authors
al Qattan MM. Manktelow RT. Bowen CV.
Title
Pregnancy-induced carpal tunnel syndrome requiring surgical release longer than 2 years after delivery.
Source
Obstetrics & Gynecology. 84(2):249-51, 1994 Aug.
Abstract
OBJECTIVE: To determine the percentage of patients in whom carpal tunnel syndrome was induced by pregnancy, the presence of any risk factors causing persistent symptoms after delivery, and the outcome of surgical decompression in these patients.

METHODS: We reviewed retrospectively the records of 100 consecutive women treated by carpal tunnel release in our unit from 1988-1991.

RESULTS: Seven patients had the onset of hand symptoms during pregnancy. One patient was diabetic and worked as a machine operator, but none of the others had predisposing factors that could have led to persistent postpartum symptoms. The hand symptoms persisting after delivery initially required conservative treatment only. However, 2-16 years later, symptoms became severe enough to warrant surgical release of the carpal tunnel. All patients had resolution of symptoms after surgery.

CONCLUSION: Some patients with mild residual hand symptoms due to carpal tunnel syndrome may initially respond to conservative treatment, but 2-16 years later, symptoms may become severe enough to warrant surgical release. We recommend long-term follow-up of patients with residual postpartum hand symptoms.


Authors
Ditmars DM Jr.
Title
Patterns of carpal tunnel syndrome. \[Review\] \[39 refs\]
Source
Hand Clinics. 9(2):241-52, 1993 May.
Abstract
Patterns of carpal tunnel syndrome have been presented, each with characteristic history and physical examination findings. Overlap is common; however, a prominent pattern can usually be identified to recommend primary treatment. The cumulative trauma patterns of tenosynovitis and position can be controlled in about two thirds of cases by nonsurgical management. The other major cumulative trauma pattern, vibration, usually requires avoidance, which commonly involves a job change. The lumbrical pattern responds to surgery with special attention to complete distal release of the transverse carpal ligament. External pressure from tool use requires design modification. Anatomic variations due to arthritis, tumors, or trauma are contraindications for the endoscopic techniques. \[References: 39\]
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