Carpal Tunnel Syndrome After Pregnancy " Judy a 42-year-old corporate lawyer "

Case study ( 7135 views as of June 18, 2024 )

Judy is a 42-year-old corporate lawyer who visits her doctor complaining of bilateral hand and wrist pain, in her palms as well as the index and middle fingers, along with some tingling and numbness. She just recently had a baby, and is back to work 6 weeks later. She had this issue beginning in pregnancy. She feels her hands are somewhat weak. She types a great deal all day.

On exam, she’s 5’2” tall. She has a positive Tinel’s sign and Phalen’s sign on both sides, with some complaint of numbness on testing sensation in the palm side of her index and middle fingers on both sides. Her neck exam is normal.

Judy would benefit from a consultation with a physiotherapist to work on stretching and posture. She likely requires an ergonomic assessment, given that she types a lot and also is in the lower end of the height bell curve. Most equipment fits people between 5’5” and 5’10”, at best. She may require wrist splints for nighttime as well; this reduces pressure on the median nerves, the nerves that are compressed in carpal tunnel syndrome.

Judy may also wish to consider consulting with a massage therapist and/or a chiropractor for additional treatment options that could help relieve her carpal tunnel pain.

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Conversation based on: Carpal Tunnel Syndrome After Pregnancy " Judy a 42-year-old corporate lawyer "

Carpal Tunnel Syndrome After Pregnancy " Judy a 42-year-old corporate lawyer "

  • Ganglion cysts can vary in size, ranging from very small to several centimeters in diameter. The exact cause of these cysts is not fully understood, but they are believed to develop due to a leakage or bulging of the synovial fluid from the joint or tendon sheath. The cysts may appear suddenly or gradually over time. While ganglion cysts are typically harmless and painless, they can sometimes cause discomfort, especially if they press on nearby nerves or interfere with joint movement. In some cases, they may resolve on their own without any treatment. However, if a cyst becomes bothersome or causes pain, various treatment options are available, including observation, aspiration (draining the fluid with a needle), injection of corticosteroids, or surgical removal. The choice of treatment depends on factors such as the size, location, and symptoms associated with the cyst.
  • Carpal tunnel syndrome (CTS) is a condition characterized by compression of the median nerve at the wrist within the carpal tunnel. The carpal tunnel is a passageway in the wrist covered by a ligament called the transverse retinacular ligament. The median nerve gives sensation to the thumb, index, long finger, and half of the ring finger. The most common symptom of CTS is numbness in the affected fingers, typically at night or in the morning. The numbness is caused by the compression of the median nerve when the nine tendons passing through the carpal tunnel swell at night. As people move their fingers in the morning, the fluid is pushed out of the tendons, and the numbness usually subsides. Patients may also experience numbness and pain during the day when the hand is in positions other than straight. Activities such as blow-drying hair or driving a car can exacerbate the symptoms. Most cases of CTS are considered idiopathic, meaning there is no identifiable cause, and it is believed to be related to the individual's anatomy. As people age, their tendons naturally swell, and if they have a relatively small carpal tunnel, CTS may develop at some point in their life. While repetitive finger movements, such as typing, are often associated with CTS, the condition is not primarily caused by repetitive finger use. Instead, it is more closely related to the size of the carpal tunnel and the changes that occur in the tendons as individuals age. In some cases, certain medical conditions like hypothyroidism or inflammation from conditions like rheumatoid arthritis can contribute to CTS. However, for the majority of patients, the cause is idiopathic. If someone suspects they have carpal tunnel syndrome based on the symptoms described, they should consult their family doctor for a proper diagnosis and to discuss potential treatment options. Early diagnosis and appropriate management can help alleviate symptoms and prevent further progression of the condition.
    • The carpal tunnel is a narrow passageway located on the palm side of the wrist. It is formed by the carpal bones, which are small bones in the wrist, and a strong band of tissue called the transverse carpal ligament. Within the carpal tunnel, there are nine tendons that help in flexing the fingers and the median nerve. When there is increased pressure or inflammation within the carpal tunnel, it can compress the median nerve, leading to symptoms such as pain, numbness, tingling, or weakness in the hand and fingers. These symptoms are typically felt in the thumb, index finger, middle finger, and half of the ring finger. Carpal tunnel syndrome is a common condition and can be caused by various factors, including repetitive hand movements, wrist injuries, certain medical conditions like diabetes or rheumatoid arthritis, hormonal changes, and genetic predisposition. Treatment options for CTS range from conservative measures such as wrist splinting, physical therapy, and lifestyle modifications to more advanced interventions like corticosteroid injections or surgery, depending on the severity of symptoms and individual circumstances.
  • Carpal Tunnel Syndrome is a condition that can worsen over time if left untreated, although non-surgical treatments can help slow its progression. Wearing a brace or splint at night and during the day can keep the wrist in a neutral position and reduce pressure on the median nerve. Modifying job or recreational activities that contribute to symptoms can also be beneficial. Anti-inflammatories and cortisone injections can provide temporary relief from pain and inflammation. However, these non-surgical treatments rarely lead to permanent resolution of symptoms. In cases where symptoms occur on a daily basis and non-surgical options have been unsuccessful, surgery may be recommended. Ideally, surgery should be performed before constant numbness occurs in the hands, as permanent damage to the median nerve may limit the effectiveness of surgical decompression. The surgical procedure for Carpal Tunnel Syndrome is called Carpal Tunnel Release. It involves cutting the transverse retinacular ligament to release pressure within the carpal tunnel. The surgery is usually performed in an ambulatory care setting under local anesthesia. The procedure typically takes less than 15 minutes, and the wound can be closed with dissolving or non-dissolving sutures. Most patients do not require narcotic pain medication after surgery. Over-the-counter pain relievers such as Tylenol and anti-inflammatories are usually sufficient. Light washing of the wound is allowed after 48 to 72 hours, but soaking the wound or exposing it to a dirty environment should be avoided for the first 10 to 14 days. Finger movement is encouraged to reduce swelling and prevent stiffness, although heavy activities may be painful initially. The surgical site may remain tender for several months, and there may be a localized area of hardness around the incision site that gradually subsides over six to twelve months. Deep massage of the area is recommended after two weeks to accelerate scar softening and decrease tenderness. Grip and pinch strength typically return within 3 to 6 months, although it may take longer for some patients. Intermittent symptoms of numbness usually resolve rapidly, but if there is pre-existing constant numbness, it may not completely resolve over time. Infection around the surgical site can occur, but it is usually treated with oral antibiotics. Increased pain, redness, and drainage should be reported to the surgeon or primary care physician for evaluation and appropriate management.
  • Heavy, repetitive use of the hand can lead to swelling of the flexor tendons.
  • The median nerve travels through a narrow tunnel within the wrist, called the Carpal Tunnel.
    • There is often a specific injury to account for the onset of symptoms.
    • Light repetitive use of the fingers is can often be a cause of Carpal Tunnel Syndrome.
    • Within the Carpal Tunnel there are 9 flexor tendons that connect to and move the fingers.
  • With a positive Tinel sign, the patient feels tingling when the area is tapped lightly as a result of irritated nerves. A positive Phalen sign is when the back of both hands are pressed together with fingers pointing to the floor and numbness develops. This indicates excessive pressure to the wrist nerves. Since carpal tunnel syndrome is directly related to pressure on the nerves in this area, positive tests on both sides means Judy has carpal tunnel syndrome in both wrists.
    • For the Tinel sign, the patient would have the inside of their wrist tapped, just below the palm of their hand.
    • Thanks @AllieS. Do you know where on the wrist they would "tap" the tinel sign in a carpel tunnel assessment ?
  • What does it mean that she has a positive Tinel’s sign and Phalen’s sign on both sides ? How is that diagnosed ?
  • What is the correlation between pregnancy and carpal tunnel syndrome?
    • While your pregnant your body produces more blood and fluid. The excess fluid can cause compression of the nerves in areas that otherwise wouldn't be affected and result in carpel tunnel. It's the same reason that some women find their shoe size increases a full size
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    • I developed carpel tunnel while pregnant and it lasted about 6 weeks postpartum. I wonder if her symptoms have lasted longer because she returned to work so early
  • This lady would benefit from having Acupuncture to open up the joints. Especially when women give birth, they use a lot of blood during the birthing process so their extremities get starved for fresh blood. Acupuncture helps to relieve congestion/inflammation so that blood can move into the area smoothy. Possibly she has not had enough rest to rejuvenate her body either and is now doing double duty with a job and a new baby at home to look after. She would also benefit from having Cupping Therapy. Cupping Therapy on the back would help to promote circulation and fortify her blood and promote her immune system functions better.
    • I find this interesting. My acupuncturist actually recommended the opposite. She doesn't like to do acupuncture until 6 weeks post partum
    • @julianne that is really interesting to know. Would having acupuncture right after giving birth helped this patient avoid Carpel Tunnel Syndrome?
  • I often wake in the night up with numbness and tingling in my small finger and ring fingers. It goes away once I more my fingers around. Could this be the beginning of carpel tunnel syndrome?
    • Carpel tunnel syndrome occurs when one of the major nerves to the hand, the median nerve, is squeezed or compressed as it travels through the wrist.
    • Do you sleep on your side? You may be laying on your arm and cutting off blood circulation to your fingers. I do that sometimes!
  • Is sleeping with a wrist splint recommended to assist with the pain while sleeping ? How does this actually help the injury for the rest of the day, or is the pain more prominent at night ?
  • I had what was thought to be carpel tunnel a few months after the birth of my son. I was 37 yrs old at the time. A friend read an article, & suggested I see a plastic surgeon. I did, as the pain was excruciating. The plastic surgeon said it was tendinitis..advising it was commonly misdiagnosed as carpel tunnel. He did a quick surgery in the hospital, removing the scar tissue in my wrists. It is now 17 years later, & I have never hd the pain again. I would strongly recommend anyone diagnosed with carpel tunnel go see a plastic surgeon to have it looked at.
  • Carpal tunnel is so painful. I feel for everyone who has to live with the pain. From what I was told by my Orthopedic Surgeon carpal tunnel isn't caused by pregnancy but by the make up of your wrists. If pregnancy brings on the symptoms, you were predisposed to it and became symptomatic because of pregnancy (or job related reasons). It runs in families as well, usually the people with like body make up will share something like this.
    • @carrle, what strategies helped relieve your pain? Did you try a chiropractor or physiotherapist?
  • I had carpal tunnel surgery while pregnant and until about 8 weeks post partum. Mine was caused by fluid retention causing pinching of the nerves. Wearing braces helped considerably
    • How do the braces help to ease the fluid retention?
    • This was exactly my situation. I retained so much fluid that it was causing pinching of the nerves. It took about 8 weeks for all of the fluid to go away
    • I am not a doctor, but often during pregnancy we retain more fluid so that is one reason. When the "tunnel" is narrowed from swelling or pressure the nerve can get pinched.
    • I am not a doctor, but often during pregnancy we retain more fluid so that is one reason. When the "tunnel" is narrowed from swelling or pressure the nerve can get pinched.
    • @drwade, what is the connection between carpel tunnel syndrome and pregnancy?
  • If you think you have carpal tunnel syndrome or have other questions, you could consult a physiotherapist, your family doctor, or a sports medicine physician.
    • Is that the nerve conductivity test ?
    • I was referred to Neurologist who did an electrode type test on my carpal tunnel syndrome.
  • The typical treatment for carpal tunnel syndrome would include splinting
    • I have heard that B6 supplements can also benefit. Do you have any information on that?
  • The carpal tunnel is the area through which the median nerve, which is a nerve that comes from the forearm and goes into the hand, the carpal tunnel is right here. It’s formed by a band or a retinaculum on the top of the wrist.
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