Carpal tunnel syndrome (CTS) and pregnancy

How does the carpal tunnel syndrome evolve during pregnancy?

Due to the hormonal change, the women’s body increases storing water, especially in the last third of the pregnancy

This also leads to an increased amount of water in the carpal canal. If the canal is tight – due to the individual shape – the pressure on the median nerve, leading through the carpal canal, increase.

The illustration shows the carpal canal. The arrow marks the roof of the carpal tunnel. In case of an increased amount of liquid in the canal, the roof and the bones can not yield and the pressure on the median nerve evolves.

What symptoms are caused by the carpal tunnel syndrome during pregnancy?

paraesthesia and pain in one or both hands are dominating. Hereby, the pain can spread into the whole arm.

The nightly complaints can be agonizing, if they occur multiple times during night and causes the patient being sleepless.

 

Can a carpal tunnel syndrome be surgically treated during pregnancy?

This is basically possible. Due to modern anaesthetic, and other procedures (e.g. plexus anaesthesia) the risk for the mother and the child is tolerable.

This applies especially if the surgery takes place in the last third of the pregnancy and the hand surgeon and the gynaecologist cooperate closely.

Should the surgery at all be performed during pregnancy?

That is the right question:

Every affected woman should be basically aware of the fact that with agonizing discomforts, such a surgery can be necessary and useful.

On the other hand, every affected women should be aware of the fact, that after childbirth (and eventually the breastfeeding period) many carpal tunnel syndromes subside! Multiple studies gave clear evidence on this point over the last years. The symptoms subsides after pregnancy and breastfeeding period with 50% of women with carpal tunnel syndrome during pregnancy!

I recommend to have an attempted treatment with a night resting cast before a concrete decision for a surgery during pregnancy – with mostly during night time occuring pain.

Even if the risk of an infection is less for a 30 year old women, compared to an 80 year old diabetic, it always needs to be considered that certain risks of a surgery can affect those two persons and  a many drugs are not for use during pregnancy.

Can an eventually necessary surgery be performed always after weaning?

Yes. But the mother needs to consider for scheduling the surgery that parts of the baby care (diaper changing, bathing of the child, etc.) needs to be done by a third person within the first 2-3 weeks after the surgery.

A used diaper is full af bacteria! Even if the wound on the hand is sewn and is additionally protected by a bandage, it can not be ruled out that e.g. during changing diapers or bathing the child bacteria can get into the wound and cause an infect.