Managing Carpal Tunnel Syndrome

Carpal Tunnel Syndrome, A Condition Common In Pregnancy

Carpal Tunnel Syndrome experienced during pregnancy is typically only a mild and temporary episode. With symptoms generally resolving soon following giving birth. However, some women may suffer with more severe symptoms, lasting several months, going on to cause discomfort postpartum and is often made worse when performing activities including breastfeeding, or settling their baby.

Swelling of feet and ankles during pregnancy is well documented, less frequently reported but still common, is the presence of swelling in the wrist and hands. Swelling in the wrist region can place women more at risk of developing carpal tunnel syndrome during pregnancy. A situation more prevalent during the later stages of pregnancy, more than during the first, or even second trimester when swelling in this area isn’t as common. The result of any pregnancy related swelling at the wrists in the carpal tunnel, may in turn lead to an increase in pressure exerted on the median nerve as the relative “room” in the tunnel becomes crowded causing symptoms. The reduction in swelling in the peripheries postpartum is frequently fairly rapid, which is why once giving birth many women find their carpal tunnel symptoms often improve rapidly as the pressure in the “tunnel” subsides.

Treatment Options

If someone is suffering with carpal tunnel symptoms then there are a number of changes to daily routines, or potential self treatment approaches that can be successfully used to assist in the management of carpal tunnel syndrome.

• Making some adjustments to both work and recreational activities is a great starting point. Whenever possible in the short term attempting to avoid jobs, or activities requiring repetitive hand movements can help alleviate symptoms. Playing a musical instrument for example is something that if this is a recreational activity only then consider putting it on hold (or at least significantly reduce practice time) to help settle the symptoms.
• Vibration has been shown to be a significant risk factor in developing carpal tunnel syndrome. Again where possible try avoiding activities involving vibrating tools, or equipment. If unavoidable, then take regular breaks when performing repetitive activities with your hands, or using vibrating equipment at work, or home.
• During the night try to avoid sleeping on your hands and wrists. Some wrist positions during sleep can compromise the tunnel space, compress or stretch the nerve for hours on end, be sure to change position during the night if you experience pain, switching to a new position may assist by relieving pressure on the nerve.
• If symptoms at night become a significant factor, or in an attempt to avoid them becoming so, try wearing a wrist splint at night when sleeping. Wrist splints worn at night are an effective treatment approach in providing relief from carpal tunnel syndrome. If this does not help alleviate symptoms then under appropriate guidance you may also consider wearing wrist supports during the day.
• For office workers, sometimes even minor adjustments to your keyboard, mouse and sitting position at your desk can influence the position your wrist is in, therefore reducing pressure in the carpal tunnel. Requesting an ergonomic assessment at work of your workstation may go a long way to helping manage the condition. If it is your mouse hand you could consider a vertical mouse as this alters the rotation of your wrist when compared to a regular mouse and changes the tension on the nerve. I have found many people with right handed symptoms at the desk find changing mouse or switching the mouse to the left side can provide some relief.
• Hot and cold packs may not significant alter the healing process but for many individuals these therapeutic aids can provide some relief to symptoms.

Medications

In Australia a physiotherapist can not prescribe medications, so it is best to talk to your GP, or pharmacist regarding appropriate medications for the management of carpal tunnel syndrome. Common medications used include nonsteroidal anti-inflammatory drugs (NSAIDs) such as Neurophen, or Voltaren the use of NSAID’s can be oral or even topical such as Voltaren Emulgel.
These oral medications, topical creams, or even corticosteroid injections injected into the carpal tunnel around the nerve in many situations may assist in relieving symptoms. During pregnancy it is even more important to remember to check with your GP, midwife, or obstetrician before taking any medications for whatever reason.

Surgery For Carpal Tunnel Syndrome

If pain and other symptoms persists, especially if muscle wasting and weakness is present then you could be a candidate for surgical intervention. The goal of surgical intervention with carpal tunnel symptoms is to relieve the pressure on your nerve and is referred to as a carpal tunnel release. A carpal tunnel release is the usual procedure and with this a small incision is made in the palm at the wrist so the surgeon can cut the transverse carpal ligament, this transverse carpal ligament is the tissue that pushes onto the median nerve with carpal tunnel syndrome and pressure here creates symptoms. Surgery for wrist pain from carpal tunnel is typically a very successful procedure, however it can depend on how long and how severe the symptoms have been prior to having the procedure.

I Think I Have Carpal Tunnel Symptoms

If you suspect you have carpal tunnel syndrome then the first step is to consult your GP, or physiotherapist to help confirm the diagnosis. A physiotherapist, or GP can offer you further management advice over and above what you have already tried. Based on the presentation these practitioners can advice if they feel any investigations, or more invasive management is appropriate. There is some evidence to suggest that a deficiency in vitamin B6 may be a risk factor for carpal tunnel syndrome. Your GP can test for deficiency and subsequently advise and treat accordingly.

Disclaimer: Sydney Physio Clinic does not endorse any treatments, procedures, products mentioned. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific advice or assistance on Managing Carpal Tunnel Syndrome should consult his or her general practitioner, physiotherapist or otherwise appropriately skilled practitioner.