Wednesday, October 10, 2012

Tackling carpal tunnel syndrome during pregnancy - By SHAMALA VELU


Pregnancy comes with its fair share of discomfort as the body makes adjustments to accommodate a growing baby. Less known to expectant mothers is a condition called carpal tunnel syndrome (CTS) which affects 20% of pregnant women during their third trimester.

This condition can be frustrating as it affects the fingers and wrists, and can range from mild to severe pain. Many women do get alarmed by the sudden discomfort in their hands but rest assured, safe treatment is available.

Carpal tunnel syndrome symptoms

Symptoms of CTS are usually numbness in the thumb, index finger and middle finger. Women who have CTS will experience a pins-and-needles or a tingling sensation in these fingers. This is sometimes accompanied by pain in the wrists and hands.

Some women complain of weakness of the hand or having a weak grasp. In one case, the loss of feeling was so severe, the mother complained she was unable to feel the temperature of her baby's milk!

Consultant hand and microsurgeon Dr Rajesh Singh says women should seek early treatment as CTS can cause significant impact on their lives, especially with the arrival of a new baby.

“Many women don't get proper advice because there isn't enough awareness on CTS and pregnancy,” he says.

CTS occurs when the median nerve is entrapped within the Carpal Tunnel causing sensations of numbness, pain and tingling at the median nerve distribution in the hand. This can also extend further up to the arms.

“The nerves are like electrical wiring. When pain is felt in one place, the underlying root problem stems from another area. CTS involves the three fingers because the root cause stems in the carpal tunnel inside the wrist area.”

Dr Rajesh showing where the carpal tunnel is. - Starpix by Azlina Abdullah

According to Dr Rajesh, the root cause of workplace CTS is different from that of CTS in pregnant women.

“One needs to take into account a person's health history and physical examination to determine the cause of CTS,” he explains.

The exact reason why pregnant women are prone to CTS is still not known though it is thought to be due to fluid retention.

However, research on CTS and pregnancy carried out by Dr Rajesh and his team in 2011 points to congestion of the vein as the more likely cause for this condition.

“Malay pregnant women are prone to the condition and have a higher risk of CTS compared to other races. We do not know the reason for this at the moment but there will be ongoing research to find out,” Dr Rajesh assures.

Prevalence of CTS in third trimester pregnancy

Although CTS is common in the third trimester of pregnancy, there is limited local data available regarding its prevalence and severity.

In one study conducted by Universiti Kebangsaan Malaysia (UKM), subjects were randomly selected among third trimester mothers attending primary maternal health care clinic at Hospital Universiti Kebangsaan Malaysia (HUKM).

Their history was obtained and a physical examination was performed for a clinical diagnosis of CTS. Those in the CTS group were interviewed using the Boston Carpal Tunnel Questionnaire for symptom severity and functional status assessment.

Out of 333 subjects, 82 (24.6%) were clinically diagnosed with CTS. Most of the CTS subjects were Malays (87.8%). Malay women were shown to have twice the risk of developing CTS in the third trimester of their pregnancy as compared to non-Malays.

The most common complaint was numbness and tingling particularly during the day (76.8%). More than half of the subjects (63.4%) had bilateral (both sides) hand symptoms while 36.6% were unilateral (one side).

The severity of CTS among subjects was predominantly mild (80.5%) and approximately one-third (34.1%) had affected hand function.

“This study shows that CTS is prevalent in the third trimester of pregnancy. CTS is usually troublesome and under-treated. Practitioners should pay more attention to CTS symptoms in pregnant ladies and referral or treatment should be offered to improve the quality of life during pregnancy,” adds Dr Rajesh.

“Fortunately, many studies have found that the timing of the first pain of CTS occurs during pregnancy was the highest during the third trimester rather than facing the pain throughout the pregnancy,” he says.

How is CTS diagnosed?

Doctors will check for pain in your hands and ask about your general health history and activities. They will then check the hands for feeling, strength and appearance. Blood tests may be carried out as well to confirm it isn't caused by any other medical problems.

The doctors may also recommend nerve testing to check the median nerve. Sometimes a nerve conduction velocity test may be performed. This test checks the rate of speed of electrical impulses as it travels down a nerve.

“In carpal tunnel syndrome, the impulse slows down as it crosses through the carpal tunnel. However, this test is very sensitive and many patients are sometimes 'over-diagnosed' with CTS. For this reason, we don't depend totally on this test alone,” he explains.

According to Dr Rajesh, performing an ultrasound on the hand and wrist is the best and most effective way to check for CTS. It gives an in-depth view of the carpal tunnel. All the content of the carpal tunnel can be seen and any problems identified.

CTS after delivery and treatment

The good news is home care is one of the best ways to treat CTS and the earlier you start, the better your chances of reducing the pain or discomfort.

Doctors will advise you to rest or use splints while working or resting. Dr Rajesh says keeping the hands elevated during the night, massages and nerve gliding exercises also helps to reduce the inflammation. Exercises that help to stretch and strengthen the muscles in the hand and arm also help to relief pain.

If your fingers feel numb at night, prop your arms up on a pillow and avoid sleeping on your hands.

However, Dr Rajesh warns that strong, repetitive hand movements or holding on to vibrating equipment like a blender can exacerbate the condition.

Fortunately, CTS usually resolves on its own after baby is born for most women. If symptoms continue after delivery, Dr Rajesh advises women to seek medical treatment.

“He may prescribe wrist splints or a safe steroid (corticosteroid) injection into your wrist do reduce the swelling,” he explains.

Steroid injections help to relief the pressure on the median nerve. Alternative treatments like acupuncture may provide some relief, but will not cure the problem, claims Dr Rajesh.

“You need to treat the root cause of the problem. The important thing is to seek early treatment before your baby is born. Otherwise the condition can get worse and it will be difficult to perform routine duties,” he concludes.
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