Carpal tunnel syndrome is common during pregnancy, particularly in the third trimester. There is little evidence to support intervention in pregnancy and symptoms are likely to resolve after the birth.
Carpal tunnel syndrome results from compression of the median nerve within the carpal tunnel in the hand. It is characterised by tingling, burning pain, numbness and a swelling sensation in the hand that may impair sensory and motor function.
60.1.1 Incidence during pregnancy
Due to differences in methods of diagnosis between studies (eg neurophysiologically confirmed, clinically diagnosed, patient-reported), there is great variability in estimates of the incidence of pregnancy-related carpal tunnel syndrome; estimates range from approximately 2% to 72%.
60.1.2 Factors influencing carpal tunnel syndrome
- In non-pregnant populations, carpal tunnel syndrome has been reported to occur more frequently in occupations that involve repetitive activity, forceful work or vibration .
- In pregnancy, likely causes of carpal tunnel syndrome are hormonal changes and oedema .
- Carpal tunnel syndrome is more common in the third trimester .
- Pre-existing or gestational diabetes may also contribute due to generalised slowing of nerve conduction but impaired median nerve conduction also occurs in pregnant women without diabetes .
60.2 Discussing carpal tunnel syndrome
60.2.1 Effectiveness of treatments
The recent evidence on interventions to treat carpal tunnel syndrome during pregnancy is limited to small case series studies (n=20–30) that found reduced symptoms associated with night splintingor steroid (dexamethasone) injections .
Activity modification, avoiding positions of extreme flexion or extension of the wrists and avoiding exposure to vibration have been suggested as adjuncts to splintingbut there is no evidence that these are effective for carpal tunnel syndrome.
While carpal tunnel syndrome usually resolves after the birth, persistence of symptoms has been reported in more than 50% of women after 1 year and in about 30% after 3 years .
Advise women who are experiencing symptoms of carpal tunnel syndrome that the evidence to support either splinting or steroid injections is limited and symptoms may resolve after the birth.
Approved by NHMRC in June 2014; expires June 2019
60.3 Practice summary: carpal tunnel syndrome
A woman has symptoms of carpal tunnel syndrome.
- Aboriginal and Torres Strait Islander Health Practitioner
- Aboriginal and Torres Strait Islander Health Worker
- multicultural health worker
- occupational therapist.
- Provide advice
Explain that carpal tunnel syndrome is common due to increased fluid retention during pregnancy and may resolve after the birth.
- Discuss treatments
Explain that there is a lack of research about treatments for carpal syndrome during pregnancy and give advice on avoiding movements that may exacerbate symptoms (eg using a splint to keep the joint straight overnight).
- Consider referral
Women with persistent and severe symptoms of nerve compression should be referred for specialist evaluation.
- Take a holistic approach
For women whose occupations involve repetitive activity or vibration advise frequent breaks or a temporary change in role where possible.
- AAOS (2007) Clinical Practice Guideline on the Diagnosis of Carpal Tunnel Syndrome. Rosemont IL: American Academy of Orthopaedic Surgeons.
- AAOS (2007) Clinical Practice Guideline on the Treatment of Carpal Tunnel Syndrome. Rosemont IL: American Academy of Orthopaedic Surgeons.
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