Dr. Bobby Chhabra, an orthopedic surgeon at UVA Health to whom Scott and other doctors refer patients with persistent, unresolved pain, answered UVA Today’s burning (and numb and tingling) questions.
Q. What is carpal tunnel syndrome?
A. Carpal tunnel syndrome is median nerve compression at the wrist. The median nerve provides sensation to the thumb, index, middle, and half of the ring fingers, while innervating the thumb muscles.
The actual carpal tunnel is a space bordered by the wrist bones and a thick band called the transverse carpal ligament, which creates a roof to the tunnel. These structures are rigid, so the size of the carpal tunnel cannot change. Nine tendons that flex and extend the fingers and thumb and the median nerve pass through the carpal tunnel.
Q. What are the telltale symptoms?
A. Patients commonly present with numbness, tingling and electrical shock pain into the thumbs and fingers. The symptoms often start at night, while sleeping or driving, when the wrist is placed in a flexed position, which puts pressure on the nerve.
As carpal tunnel syndrome progresses, symptoms can occur during the day, intermittently. Over time, the symptoms can become constant and lead to permanent numbness of the fingers and weakness in thumb and grip strength.
Q. Who is at risk?
A. There are certain risk factors that increase the chances of getting carpal tunnel syndrome, including obesity, diabetes, alcohol addiction, fibromyalgia and hypothyroidism. Women are more likely than men to experience carpal tunnel syndrome. It is more likely to occur with aging. It is rare in children and adolescents, and more common in ages 40 and over.
Q. How common is it with new moms?
A. About 30% of pregnant women will develop carpal tunnel in pregnancy during their third trimester.
A recent study found that about 28% of previously asymptomatic women had symptoms of carpal tunnel syndrome in their third trimester. The vast majority of these women (85%) had resolution of symptoms by six weeks postpartum.
Q. What is “mommy wrist”?
A. “Mommy wrist” is different than pregnancy- or postpartum-related carpal tunnel syndrome. Painful, inflamed tendons in the wrist and hand, mainly the thumb, are often experienced by new mothers.
Also, De Quervain’s tenosynovitis (tendonitis of the thumb) is very common in new mothers, who often lift their child over and over again for feeding and care.
Q. How do moms get carpal tunnel syndrome?
A. Pregnancy, hormonal changes and extra body fluid retention may add swelling and pressure on the median nerve in the carpal tunnel and cause symptoms, most commonly during the third trimester.
Q. What’s the best way to get better?
A. Pregnancy-related carpal tunnel syndrome is difficult to avoid, but symptoms can be treated with wrist splinting, avoidance of aggravating activities (repetitive wrist-flexing activities) and cortisone injections until symptoms resolve postpartum.
My colleague, Dr. Scott, notes that oral anti-inflammatory medicines are not typically recommended in pregnancy, which can limit our ability to treat the pain. Steroid injections, however, can be safely performed in pregnancy and should be discussed with your obstetrician and orthopedic surgeon as a possible treatment option.
For De Quervain’s tendonitis, wearing a thumb/wrist splint during baby lifting, feeding and care can help treat and prevent symptoms from getting worse.
Q. Does that last answer imply having one’s partner do more lifting will also help?
A. Yes, having help to care for the baby will reduce the chance of overuse tendonitis.
Q. When is surgery necessary?
A. If symptoms of carpal tunnel syndrome get worse despite conservative treatment, surgical release of the carpal tunnel ligament is one of the most effective treatments. It takes the extra pressure off the median nerve immediately. There are several different surgical techniques to divide the transverse carpal ligament, which opens the ligament, so there is more room for the tendons and the nerve to pass through the tunnel without pressure.
Q. Anything else readers should know?
A. If you have symptoms, regardless of the cause, please make an appointment to confirm the diagnosis and discuss the best treatment options. Persistent symptoms that fail to respond to non-surgical and conservative measures are best treated with surgery.