04.29.2013 / Blog Posts Health and Wellness
During pregnancy, alterations in your body chemistry and the mechanical compression of the uterus on a major vein in your body can lead to changes throughout the body. These changes can result in several conditions that can cause problems in your hands and wrist and can also cause numbness, pain, and even masses to develop. This blog will address carpal tunnel syndrome.
Carpal Tunnel Syndrome
Inflammation and swelling in the lining of some of the tendons in the wrist can lead to compression of the median nerve, a nerve that passes through the wrist. This can lead to numbness in the thumb, index, middle, and sometimes ring fingers. It can also lead to hand and forearm pain. This can lead to difficulty holding objects and sleep interruption. Repetitive actions and positioning of arms can lead to exacerbation of symptoms. This syndrome is called carpal tunnel syndrome.
Carpal tunnel syndrome in pregnancy is a condition that is initially treated with night bracing. Using nonsteroidal anti-inflammatory drugs such as ibuprofen (Motrin, Advil), naproxen (Naprosyn, Aleve), and diclofenac (Voltaren) are controversial and most healthcare prescribers will avoid using them. Corticosteroid injections can be used for moderate to severe symptoms. There is low risk that they will cross the placenta because there are injected locally. Injections may also increase blood sugar levels but these effects are transient. Usually carpal tunnel syndrome symptoms related to pregnancy will resolve after delivery. If symptoms persists nerve tests should be performed to confirm diagnosis and potentially surgery may be needed.
Cubital Tunnel Syndrome
Cubital tunnel syndrome is a similar condition where the compression is on the ulnar nerve. This can lead to numbness in the ring and small fingers as well as pain in the hand or forearm. Individuals can experience symptoms that interrupt sleep as well cause weakness and fatigue. The site of compression most frequently happens at the elbow. Resting the inside of the elbow on hard objects or flexing elbow can exacerbate symptoms. This condition is treated with night bracing and activity modification.
Inflammation of tendons on the thumb side of the wrist can also develop. There are two tendons that travel together that are responsible for the movement of the thumb away from the rest of the fingers. They travel in a tendon sheath or tunnel that can pinch the already inflamed tendons when the wrist is placed in certain positions. DeQuervain syndrome is a condition that experienced more commonly after delivery. Repetitive actions, lifting children, or certain wrist positions can lead to exacerbation of pain. This is treated with bracing and corticosteroid injections.
All suspicious masses and lesions should be evaluated by the appropriate person. Pyogenic granuloma is a benign mass that develops during pregnancy with the highest likelihood during first trimester. It is a rapidly growing mass that can appear anywhere on the hand and easily bleeds. This lesion usually resolves after pregnancy, but in some cases needs to be cauterized or even surgically excised if it persists.
Frederick Scott, Jr.,, MD; Commonwealth Orthopaedics
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