Alison Bedford – Women’s Health Physiotherapist
Common complaints during the childbearing years are pain, weakness and pins and needles in the wrist and hands. There can be many causes and conditions that may bring on these symptoms so it is always best to seek assessment from your midwife, doctor or physiotherapist. However one diagnosis is Carpal Tunnel Syndrome (CTS).
CTS is caused by compression of the median nerve in the carpal tunnel, which is a space at the base of the hand and thumb. During pregnancy the body retains more fluid causing swelling in the hands and this can lead to compression of the nerve and tendons. Symptoms can include pins and needles, numbness, pain, and reduced strength in one or both hands. During the night or in the morning symptoms are often more prevalent.
In most cases, CTS resolves after baby is delivered and the fluid retention decreases however it can also continue postnatally due to breastfeeding hormones and high work load on the wrists and hands caring for baby.
Rest – avoid overusing your hands, doing repetitive tasks and awkward wrist postures. Reduce the amount of time on your phone and take regular breaks if using a computer following the 20-20-20 rule. Every 20 minutes spend 20 seconds looking 20 feet away and rest your wrists and hands or do some stretches.
Pain relief – paracetamol and ibuprofen (tablets) or ibuprofen spray or creams can help relieve symptoms, speak to your healthcare professionals for more advice.
Ice – use an icepack or even frozen peas wrapped in a tea towel on the affected area for 10 minutes. Alternatively bathing your hands in cold water can help. Contrast bathing is another method where you bath your hands and wrists in warm water and then cold water spending 1 minutes in each and alternating for 6 minutes.
Elevation – keep your hands elevated when resting and at night higher than the level of the heart to help reduce swelling. Try resting with your hands on pillows.
Sleeping positions – during pregnancy it is recommended to sleep on your side but avoid sleeping on your hands or with your wrists bent. It is best to sleep with your wrists straight.
Carpal tunnel wrist support with metal – these can be purchased online or from local pharmacies. Wearing wrist splints at night can help to reduce pain and swelling.
If the pain is not too severe and after some rest, exercises can help to improve circulation and reduce swelling in the wrists. Your physiotherapist can prescribe you with appropriate exercises. Here are some examples below of ranged of motion exercises for the fingers and wrist and median nerve glides. You can repeat these exercises up to 10 times and do them 1-2 times per day.
- Usually, symptoms will subside after 6 weeks following the birth of your baby as the hormones and fluid levels return to normal. However, you need to protect your wrist and hands in the first few weeks postnatally to allow the muscles to strengthen to help look after your baby.
- Continue to wear the splints as much as possible with baby care activities and at night. When holding baby during the day you can take the metal part of the support out.
- Seek help for baby bathing and changing nappies as much as possible to prevent excessive strain on the wrists and hands and avoid over stretching or straining your wrist.
- If your symptoms continue beyond 6 weeks postnatally please speak to your GP for further advice and referral. In some cases, steroid injections may be indicated to help reduce inflammation and allow you to build strength again in the hand.
- If conservative methods have not been successful another option is carpal tunnel release surgery.
- With either injections or surgery make sure you have support with your baby during the recovery time so you can rest and slowly build up your strength again.
‘I had symptoms of carpal tunnel syndrome during my pregnancy mostly at night. I wore wrist splints and did some exercises which helped. I also found swimming helped to reduce swelling and relieve my symptoms. During the postnatal year my symptoms worsened and I had steroid injections which only had a short term effect. After much consideration I undertook having carpal tunnel release surgery on both my wrists when my little boy was 10 months old. It was a long recovery time but now I feel my wrists strong again and my night pain is gone. I still make sure to take regular breaks, avoid using my phone too much and continue with some basic wrist and hand exercises and stretches.’
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