CARPAL TUNNEL SYNDROME

What is it?

Women can commonly experience carpal tunnel syndrome (CTS) throughout pregnancy and also in the postnatal period. CTS occurs when there is pressure on the median nerve which travels through the carpal tunnel located on the underside of your wrist. It can occur in pregnancy due to an increased amount of fluid within the body which increases internal pressure within joints and in this instance, the wrist and carpal tunnel. In the postnatal phase, CTS can occur due to prolonged and repetitive movements involving flexion (bending) of the wrist during tasks such as breastfeeding, lifting and carrying their baby.

Symptoms

In most instances, people present with the following symptoms:

    • Pain / tingling / pins and needles into hand and fingers
    • Wanting to shake hand to relieve pain 
    • Typically worse in morning after waking – this is due to sleeping with wrists in the foetal position (curled in) which closes down the carpal tunnel and increases swelling / pressure into hands 
    • Symptoms can also be movement dependent i.e. flares with lifting / carrying / breastfeeding 

Physiotherapy treatment options

  • Effleurage massage 
    • This assists with moving fluid out of the fingers, hand and wrist
  • Lymphatic Drainage Massage 
    • Draining the lymphatic system on the affected side can assist with the removal of excess fluid in the hand and wrist which can reduce symptoms 
  • Compression
    • Gentle compression can assist with controlling the excess fluid build up in the wrist and hand 
    • Wearing a compression garment can also improve comfort and support for the hand and wrist
  • Splinting / bracing 
    • Wearing a specialised carpal tunnel splint will keep your wrist in a neutral (straight) position. CTS splints have a hard plate which runs up the inside of your wrist which prevents wrist flexion (bending) and subsequently keeps the carpal tunnel open. 
    • The time of day when you wear your splint is individualised to the nature of your symptoms 
  • Hot / Cold Therapy 
    • THis can assist in the removal of fluid and reducing inflammation in the wrist which can assist in symptom relief 
  • Ergonomic alteration as indicated i.e. lifting, carrying, holding 
    • The focus with these tasks will be on trying to keep the wrist in a neutral position 
  • Breastfeeding positioning alteration as indicated 
    • Breastfeeding positioning will be assessed to ensure that comfort is established and the wrist isn’t under any strain which can contribute to symptom aggravation

Other treatment options

  • Anti-inflammatory medications – always speak with your doctor or pharmacist prior to taking any medications to ensure that it is safe and appropriate for you to do so 
  • Corticosteroid injections – reduces local inflammation within the carpal tunnel and can relive symptoms 
  • Therapeutic Ultrasound (TUS) Therapy 
    • There isn’t conclusive evidence to show the exact benefit of TUS for CTS however, there are studies that demonstrate a reduction in pain and swelling at 2 weeks, 7 weeks and 6 months after a 7 week programme of TUS when compared to sham ultrasound 
  • Surgery – to release and open up the carpal tunnel which aims to reduce nerve entrapment
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