Carpal Tunnel with Pregnancy
I developed carpal tunnel in my second trimenster. Here's a great article from the Hand Pain Society...
The Bottom Line about Carpal Tunnel Syndrome
by Christian Walker, Ph.D.
(Reprinted from the Hand Pain Society, Volume 4, January 11, 2010)
WHAT IS CARPAL TUNNEL SYNDROME?
Carpal tunnel syndrome describes a condition generally known as a peripheral entrapment neuropathy. Specifically, the neurological pathology is caused because the median nerve (the peripheral nerve which goes from the hand to the arm) gets squeezed (”entrapped”) at the wrist.
Among other things, the median nerve controls sensory information sensations from the palm side of the thumb and fingers (not the little finger). The nerve passes through the carpal tunnel. This is a canal formed between wrist bones and the ligaments that hold them together. The canal forms a passageway for the median nerve, the tendons of the flexor muscles of the hand.
The entrapment occurs because sometimes the tendons and other tissues thicken. This narrows the carpal tunnel causing the median nerve to be compressed. The result of this squeezing is manifested differently in different people. It may result in pain, weakness, or numbness in the hand and wrist, and sometimes these sensations radiate up the arm.
WHAT ARE THE SYMPTOMS OF CARPAL TUNNEL SYNDROME?
It is extremely rare for the symptoms of carpal tunnel syndrome to begin quickly. Instead, the symptoms generally start gradually. The person feels sensations like tingling, burning or itching numbness in the palm of the hand and the fingers. It is especially pronounced in the thumb, index and middle fingers. Often, the fingers feel swollen, even though they are not. These sensations can occur in one or both hands simultaneously.
It is most common for the symptoms to first appear at night. Many people report waking up and having to wring or “shake out” their hands. If symptoms worsen, the sensations last into the day, generally with tingling.
As the condition progress further, the person might feel a decrease in grip strength. It becomes difficult to make a fist or grasp small objects. In severe and chronic cases that re untreated, there is wasting of the muscles at the base of the thumb and people lose sensation of hot and cold.
You can do 3 simple tests which are consistent with a diagnosis of carpal tunnel syndrome (but, for course, are not necessarily definitive tests). If you answer yes to any of these tests, then you may have carpal tunnel syndrome.
1. Phalen Maneuver
Flex your wrist gently and as far as possible (i.e., bring your fingers as close to your wrist as you can). Then hold this position for 1 minute. Do your symptoms - especially numbness - appear or get worse?
2. Tinel Test
With your hand straight, lightly tap the skin over the crease in your wrist. Does it result in a tingling or “pins-and-needles” in the hand?
3. Durkan Test
With your hand straight, apply firm pressure to the wrist crease for 30 seconds. Relax for one minute, and then apply firm pressure to the palm (just past the wrist crease) for 30 seconds. Do either of these make your symptoms (especially numbness) appear or get worse?
HOW IS CARPAL TUNNEL SYNDROME TREATED?
Carpal tunnel syndrome is not something you just get rid of with drugs, shots, or surgery. You merely suppress the symptoms because the underlying cause is both anatomical and physiological. We don't know why it rears its head when it does, although some believe repetitive strain brings it on, but more research is needed to be sure.
The traditional treatments for carpal tunnel syndrome attempt to relieve pressure on the median nerve as it passes through the carpal tunnel in the wrist. However, no single treatment choice is right for every person. The factors to consider for treatment depend on 1) How severe the symptoms are and what's causing them, 2) How long the symptoms have been felt, and 3) How much the symptoms affect the person’s life (at work and home).
Once diagnosed, treatments for carpal tunnel syndrome should begin as early as possible, under a doctor's direction. The underlying causes (such as diabetes or arthritis) should be treated first. An initial treatment generally involves resting the affected hand and wrist for at least 2 weeks. This means avoiding activities that may worsen symptoms, and immobilizing the wrist in a splint or brace to avoid further damage from twisting or bending. Cold packs are used if there is inflammation in order to help reduce swelling.
Carpal tunnel syndrome treatments fall into two general categories: surgical and nonsurgical. Both have potential risks and benefits.
Most people with carpal tunnel syndrome should at give nonsurgical treatments a try. These treatments work best below the age of 50 and if the symptoms are mild to moderate, not constant and began less than 10 months prior to evaluation.
The great advantage of nonsurgical techniques for carpal tunnels syndrome it that they are less invasive than surgery and most people obtain at least short-term relief from one or a combination of nonsurgical treatments. The great disadvantage of nonsurgical techniques for carpal tunnels syndrome is that they usually are effective only in cases of mild to moderate carpal tunnel syndrome. They may not provide permanent symptomatic relief especially for advanced cases.
Also, nonsurgical treatments may lead a person to postpone an operation that is inevitable. If too much time elapses before deciding on surgery, it may reduce the chance of a completely successful operation.
For most people, the position of the wrist position is vital to controlling the symptoms of carpal tunnel syndrome. The more the wrist is bent, the more pressure is put on the median nerve. Therefore, precautions to take in order to protect one’s hands include:
Reduce wrist bending. Avoid bending the wrist all the way up or down.
Relaxing grip. Avoid gripping too hard when driving, writing or using hand tools. Most people use more force than necessary when doing hand tasks.
Choose tools wisely. When writing, use a thick pen with an oversized, soft grip adapter and free-flowing ink. Modify hand tools such as going from a straight handle to a pistol grip. Avoid vibrating tools.
Take breaks. When performing activities that require repetitive, forceful motion with wrists bent, stop every 15 to 20 minutes and gently stretch and bend the hands and fingers.
Use proper posture. Poor posture causes the shoulders to roll forward, shortening the neck and shoulder muscles and compressing nerves in the neck.
Keep hands warm. Pain and stiffness are more likely to occur if hands are cold.
Splints (braces) are the most commonly used non-drug treatments for carpal tunnel syndrome. These immobilize the wrist in a neutral position and most people use them during sleep. They are generally effective to varying degrees
Active medical devices
The Carpal Therapist is a relatively new device and is unique in that it is an electrically powered massaging device. It combines the immobility features of the brace with active therapeutic massaging as from a physical therapist. Electrical motors in the brace massage the tendons of the wrist, stretching the tendons and reducing swelling in the carpal tunnel.
The Carpal Solution is a device very much related to a brace in its concept and to some extent, its function. This reportedly causes stretching and re-shaping of the wrist’s anatomy using a three pronged tape system.
WristTrac is another device targeted for carpal tunnel syndrome. This device is a brace with a built in stretching mechanism and reportedly results in stretching of the forearm tendons in a manner similar to traction.
When the symptoms of carpal tunnel syndrome are mild to moderate, physical therapy or special hand exercises can be used for relief. There are certain exercises that can be used which include gliding exercises to help relieve carpal tunnel syndrome symptoms, and when used in combination with other treatments, such as splinting, they appear to be more beneficial. Ultrasound and contrast baths are said to provide short term relief, but may not be very effective in more severe cases of carpal tunnel syndrome.
The most common treatment for carpal tunnel syndrome is symptomatic relief using drugs. Drugs can ease the associated pain and swelling, particularly nonsteroidal anti-inflammatory drugs like aspirin, ibuprofen, naproxen, and ketoprofen. Diuretic pills ("water pills") can decrease swelling and may offer pain relief. Corticosteroids (such as prednisone) or the lidocaine can be injected directly into the wrist or taken by mouth (in the case of prednisone) to relieve pressure on the median nerve and provide immediate, temporary relief to those with mild or intermittent symptoms. This is also true of vitamin B6 (pyridoxine) supplements. However, persons with diabetes and those who may be predisposed to diabetes should note that prolonged use of corticosteroids can make it difficult to regulate insulin levels.
In situations where symptoms are not too severe, stretching and strengthening exercises can be beneficial. These exercises should be supervised by a doctor or physical therapist. Additionally, an occupational therapist may be sought because they are trained in evaluating people with physical impairments and helping them build skills to improve their health and well-being.
One of the most common surgical procedures in the United States is carpal tunnel release. This is generally recommended if carpal tunnel syndrome symptoms last for 6 months. The surgery involves severing the band of tissue around the wrist to reduce pressure on the median nerve. The following are types of carpal tunnel release surgery:
Open release surgery, is the traditional procedure used to correct carpal tunnel syndrome. This consists of making an incision up to 2 inches in the wrist and then cutting the carpal ligament to enlarge the carpal tunnel.
Endoscopic surgery is far less traumatic and allows for faster functional recovery and less postoperative discomfort than traditional open release surgery. Either two or one (double portal or single portal carpal tunnel surgery, respectively) tiny incisions are made in the wrist and palm. A camera and surgical instruments are inserted in the incisions in order to cut the carpal ligament.
Full recovery from carpal tunnel surgery can take days to months, although symptoms may be relieved immediately afterward. Additional results in some patients may be infection, nerve damage, stiffness, and pain at the scar. Occasionally the wrist loses strength because the carpal ligament is cut.
Recurrence of carpal tunnel syndrome following treatment is not uncommon. However, the majority of patients recover completely.