Hand and Wrist Issues in Pregnancy and the Postpartum Period
Hand and Wrist Issues in Pregnancy and the Postpartum Period
You don’t have to be a physio to know that your hand is a long way from your pelvis, so you might be wondering why The Pelvic Studio is talking about hand, wrist and arm problems. But unfortunately upper body issues are extremely common in pregnant and postnatal women and although hand, wrist and fore-arm pain is not our primary area of expertise, it is not uncommon for our physios to help mummas and mummas-to-be with their upper body aches and pains. While we certainly don’t claim to be experts, we can offer you some general tips and provide you with treatment options.
Pregnancy Wrist Pain
A systematic review found that 30-50% of women will experience some wrist pain symptoms while pregnant, especially in the third trimester (Padua et al., 2010).
Many pregnant women report that wrist pain disrupts their sleep at night (Meens et al., 2015).
Postnatal Wrist Pain
Wrist pain doesn’t necessarily resolve after birth. A 2017 study found that 48% of mothers still had wrist pain at 2 months post birth (Sit et al., 2017).
Unsurprisingly, those with bigger babies are more likely to report wrist pain.
First, let’s talk about Carpal Tunnel Syndrome.
You’ll find the carpal tunnel in the wrist, and some important nerves and tendons pass through it from your arm to your hand.
When you are pregnant, certain hormones can: a) cause some swelling of these structures and b) soften the ligament that makes up the roof of the tunnel.
When you have a young baby, you may spend a lot of time with your wrists in positions that narrow the tunnel.
All of this can cause the nerve that runs through the tunnel (the median nerve) to become squished, which can lead to symptoms, mostly in the index and middle fingers, such as:
· Pins and needles
· Numbness
· Pain, especially at night
· Weakness
· Burning sensation
· Sharp pains darting from the wrist
How can I manage Carpal tunnel symptoms?
· Avoid or modify positions/activities that make your symptoms worse (generally this will be positions/activities where your wrist is bent back or forward)
· Keep your wrist in a neutral position (ie hand in line with your forearm), especially when sleeping or lifting
· Avoid or modify repetitive activities
· Avoid letting your arm hang by your side for prolonged periods and elevate your hand (eg on the arm rest of a chair) when possible
· Apply ice over your wrist for 20 minutes every 2-3 hours
· Wear a compression bandage or tubigrip (available from pharmacies)
· Wear a wrist splint (especially at night)
· Gentle fluid drainage massage
· Gentle exercises every 2-3 hours
· If symptoms are severe or are disrupting sleep, we recommend that you see a hand physiotherapist
Does it go away after birth?
Most women will see their symptoms disappear after giving birth. However, symptoms can hang around for some women, and a small percentage may develop carpal tunnel syndrome after birth (even if they didn’t have it during pregnancy).
If symptoms persist, follow the tips above and pay particular attention to the position of your wrists when feeding and carrying your baby.
Another common complaint during pregnancy and postnatally is De Quervain’ s tenosynovitis.
This affects some tendons on the thumb side of your wrist. These tendons can be affected by extra fluid during pregnancy, causing the tendons to become irritated.
Postnatally, symptoms can be worsened as a result of awkward and repetitive hand and wrist positions involved with caring for a new-born.
Symptoms may occur on one or both hands, and include:
· Pain/tenderness in the thumb or wrist, especially when gripping with thumb pressure is required (eg pulling tabs on nappies, folding up a pram, opening jars or bottles, picking up a dinner plate, peeling vegetables)
· Swelling around the thumb side of the wrist
· Clicking/snapping sound at the wrist
How can I manage de Quervain’ s symptoms?
Symptom management is based around resting the irritated tendons
· Avoid or modify positions/activities that make your symptoms worse. This might mean
o delegating housework,
o carrying things in a bag over your shoulder rather than with your hands,
o if breastfeeding, try doing it in sidelying (see our guide here) to reduce the strain on your wrists
o if bottle-feeding, let the bottle rest in your palm rather than grasping it
o using your forearm rather than your hand to support your baby’s head
· Keep your wrist in a neutral or slightly extended position (ie hand in line with your forearm), especially when carrying or feeding your baby
· Wherever possible, hold objects with a ‘scoop’ position (ie your thumb against your index finger, rather than opposing your thumb and fingers)
· Massage the muscles in your forearm using the heel of your unaffected hand, or having someone do it for you
· Apply ice over your wrist for 20 minutes every 2-3 hours
If symptoms persist, you may benefit from a splint or taping from a hand physiotherapist
Our physiotherapy team are here to help you through your pre/postnatal journey so feel free to mention any musculoskeletal concerns during your appointments.
Physiotherapy assessments can be made online HERE or by emailing info@thepelvicstudio.com. You can also call us on 6224 7195.
The information in this blog is courtesy of the following sources:
Reference list
Meems, M., Truijens, S., Spek, V., Visser, L. and Pop, V. (2015). Prevalence, course and determinants of carpal tunnel syndrome symptoms during pregnancy: a prospective study. BJOG: An International Journal of Obstetrics & Gynaecology, 122(8), pp.1112–1118.
Padua, L., Pasquale, A.D., Pazzaglia, C., Liotta, G.A., Librante, A. and Mondelli, M. (2010). Systematic review of pregnancy-related carpal tunnel syndrome. Muscle & Nerve, 42(5), pp.697–702.
Sit, Regina W S et al. “A Pilot Cross-Sectional Study of Postpartum Wrist Pain in an Urban Chinese Population: Its Prevalence and Risk Factors.” Pain physician vol. 20,5 (2017): E711-E719.