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Physiotherapy for Pregnancy-related Hand and Wrist Conditions

Both the physiological changes of pregnancy and the demands of caring for a new baby may result in a number of women developing quite significant hand and wrist pain during pregnancy or after birth, the most common being pregnancy related carpel tunnel syndrome, post-partum carpal tunnel syndrome, and DeQuervain’s Tenosynovitis. Whilst the early symptoms of these conditions are usually pain and / or pins and needles, left untreated they can end up impacting on your ability to complete usual daily tasks such as lifting and caring for your baby.

Carpal Tunnel Syndrome

Carpal tunnel syndrome is a specific condition that affects the wrist and hand.  Symptoms most commonly occur in the palm, thumb, index, and middle finger.  Some symptoms may also occur in the ring finger, however the little finger is usually unaffected.  Whilst carpal tunnel syndrome can commence early in pregnancy, it is most common and usually most severe in the final trimester of pregnancy.

What causes carpal tunnel syndrome?

Carpal tunnel that occurs during pregnancy is usually caused by a different mechanism than carpal tunnel that occurs after birth.

During pregnancy, your blood volume increases in order to nourish and support the growth of your baby.  In addition, most of the blood vessels in your body will become softer.  The combination of increased blood volume and softening of blood vessels will often lead to an increase in fluid retention in the hands and feet, which can sometimes cause compression of the “Median Nerve” – a major nerve that travels through your wrist.  This compression is often worse at night and will manifest as a sense of numbness, tingling or pain.

Unlike carpal tunnel of pregnancy, carpal tunnel that occurs after birth is often not caused by fluid retention.  Post-partum carpal tunnel syndrome is more commonly caused by having spent prolonged periods of time with the wrist flexed (bent) e.g. whilst feeding or holding your baby.  This bent wrist position will then aggravate your median nerve giving you similar symptoms to fluid related carpal tunnel of pregnancy.

How might carpal tunnel syndrome affect my function?

Left untreated, you may find that carpal tunnel syndrome results in difficulty with fine motor skills such as writing, typing and doing up buttons on your baby’s clothes.  In severe cases, the numbness associated with carpal tunnel can also cause you to have difficulty holding objects.

Is there treatment available?

If you are diagnosed with carpal tunnel syndrome, treatment by physiotherapy may effectively eliminate symptoms.  Treatment will vary depending on the specific cause of your carpal tunnel syndrome.  It is vital to first have an accurate assessment of your hand pain by a physiotherapist, as not all hand/wrist pain in pregnancy or after birth is necessarily related to the carpal tunnel.  Management of swelling, wrist braces, soft tissue release, neural mobility exercises and strengthening exercises may be effective treatment options.

De Quervain’s Tenosynovitis

In contrast to carpal tunnel syndrome, De Quervain’s tenosynovitis is a painful condition that predominantly affects the side of the wrist, and is more common during the post-partum period.  This pain is felt at the thumb side of your wrist and is particularly bothersome during activities of lifting or grasping.  There may also be a degree of swelling and/or stiffness associated.

What causes De Quervain’s tenosynovitis?

De Quervain’s tenosynovitis is most commonly related to a sudden increase in repetitive activities such as lifting your baby, causing an inflammation of the tendons at the side of your wrist.  The most effective management of De Quervain’s tenosynovitis therefore usually involves a combination of acute treatment of the tendonitis, possible taping/strapping to reduce aggravating movements at the wrist, as well as education and advice on ways to lift and hold your baby that will not continue to irritate the tendons in the future.

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