Health Guide

Pregnancy Related Carpal Tunnel Syndrome

Introduction :
Numbness, tingling and pain in the hand caused by compression of nerves in the wrist.


Cause :
Most readers will have heard of RSI (repetition strain injury) which has been one of the "in" diseases in recent years. Carpal tunnel syndromeis one of several different conditions of the joints, bones, tendons and muscles that may cause RSI. Your wrist is made up of eight small bones, which are arranged into two lines of four bones each. These bones are all joined together by ligaments. These wrist bones are further arranged into an arch, with the open part of the arch on the palm side of the wrist. This arch is maintained by a band of ligament that runs across the open part of the arch, forming a half circle shaped tunnel, the carpal tunnel. Through this tunnel run the arteries, veins, nerves, muscles and tendons that supply and move the hand. It is thus a very crowded area. If you use your wrist a great deal (as in typing or playing the piano), the tendons running through this narrow tunnel may become strained and inflamed. They then swell, and this causes increasing pressure in the carpal tunnel, which cannot expand because it is made of solid bone and ligaments. The slow collapse of the bony arch with old age and rheumatoid arthritis, results in the same problem. Pregnancy is a very common cause of the syndrome, due to the retention of fluid, and slight swelling of all tissues that occurs. Some women find the syndrome flares just before a period with their premenstrual tension, for the same reason.


Incidence:
Typists, truck drivers, musicians, pregnant women and the elderly. Theseare the groups of people who are most likely to develop this distressing condition.


Prevention :
Strapping or splinting the wrist during repetitive use may prevent the problem from occurring.


Investigations :
Once the condition is suspected, x-rays of the wrist, and studies to measure the rate of nerve conduction in the area, are performed to confirm the diagnosis. In obvious cases, the tests may be unnecessary.


Course :
The most vulnerable structures in the carpal tunnel are the nerves, and pressure on these causes the burning pain, tingling, numbness and weakness of the hand that are characteristic of this syndrome. The symptoms are often worse after sleeping with the wrists flexed, while reading a newspaper, or gripping a steering wheel.


Treatment :
Treatment depends upon the severity and cause. In pregnancy, when the problem will probably settle after the birth, splinting of the wrist and rest are often all that is necessary. In other cases, if splinting does not work, nonsteroidal anti-inflammatory tablets (see Medication Table), fluid removing medication (diuretics - see Medication Table), and injections of steroids into the wrist may be tried. Many cases progress and require surgery to release the pressure on the nerves inside the carpal tunnel. This is a very simple operation, done under local or general anaesthetic, and the patient is left with a small scar across the wrist on the palm side. Only one day in hospital is necessary. Urgent surgery is sometimes required with severe cases during pregnancy. Obviously, the sooner the problem is treated, the less likely it is that long term problems will develop. Treatment should be sought at the first sign of discomfort in the hand or wrist, not when the pain becomes unbearable.


Complications:
Rarely, in untreated cases, permanent numbness or weakness may occur in the hand.


Outcome :
The vast majority of cases recover completely with appropriate treatment.

Carpal tunnel syndrome during pregnancy

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