Carpal Tunnel Syndrome


There are various things you can do to help carpal tunnel syndrome (CTS).

1. Yoga – wrist mobilisation exercises, eg circling gently, stretching the hand forwards and backwards – anything to increase circulation in the area.

2. Wrist splints, available from your doc or maybe pharmacist. Sleeping with these on will usually help a lot, esp. as CTS is usually worst at night. Sleep with wrists slightly elevated, eg on a pillow, and hold hands up in the air for a few moments when you first wake up.

3. Ultrasound therapy (as described below)

Other suggestions on the US Midwife Archives at Gentlebirth.org include Ice packs and Vitamin B6:

http://www.gentlebirth.org/archives/miscdisc.html#Carpal

I had carpal tunnel syndrome for the last month or two of my first pregnancy and found it really uncomfortable, often waking in the night in pain but unable to move my hands. I would have to lie there with my arms in the air for a while until I could move them at all. Sleeping with wrists elevated slightly on a pillow helped a little. It took a few weeks to go away after the pregnancy. My mother had it in her last pregnancy (and it took a while to resolve afterwards) but not in previous ones. I was not looking forward to it second time around, but it simply didn’t happen.

Angela


My trusty Anne Fry book is never far from my desk for reference , so here’s what she has to say in “Holistic Midwifery” volume one:

“The median nerve passes from the forearm to the hand behind the flexor retinaculum muscle During pregnancy , weight gain and oedema may reduce the narrow passages for this nerve, which leads to tingling pain and stiffness in the thumb, index and middle finger and radial half of the ring finger on the affected side.

“The symptoms worsen or appear at night and may cause wakefulness. Less commonly, weakness may also occur leading to clumbsiness.It is precipitated and worsened by repetive hand and wrist motion such as typing. Whe a significant degree of CTS is present , percussion over the medial nerve at the center of the wrist can cause a tingling sensation referred to as Tinel’s sign.

“Drinking skullcap infusion can help heal damaged nerves as can B6.try 25mg daily along with a Bcomplex while implementing wrist stabilisation. Discontinue B6 after 2 weeks to avoid B intake imbalance. Regular exercise helps mobilise fluid (as would any measures to help oedema). Stabilise the wrist in a straight position at night and do not sleep with head on hands or wrists. Wrist supports can be worn, especially at night.”

I am not sure whether a midwife in Britain can recommend any herbal remedies but any woman can go to her local herb shop or herbalist and ask for information.Skullcap is also used for nerves and insomnia and is good to take at night. It is also good for nervous midwives!! Homeopathy is supposed to be available on the NHS – I just told my GP what I wanted and she wrote the prescription and LO! free homeopathics!

I know St johns wort is good for sciatica and SP (synphysis pubis) pain (nerve pain) but could not see it specifically mentioned for CT. It is not contra-indicated in pregnancy and can also be taken homepathicaly (hypericum) Herbs should only be taken for 2-4 weeks at a time. A few drops of lavander and eucalyptus oil in 2tbs base oil can also be massaged into whole arm. Acupuncture has worked for some people.

Hopefully the carpal tunnel will end when the pregnancy ends.

Tania


Acupuncture and acupressure are said to be extremely effective in this condition. I have had two clients who have benefited in this way.


I am a student midwife about to start my second year so my knowledge is very limited. I had a look in my midwifery text book to see if it offered any suggestions for your problem. It mainly recommends wearing splints at night with your hand resting high on a pillow. The only other suggestion is a prescription for diuretics from a G.P.


Here is something I found in natural healing and alternative medicine newsletter put out November 98 by Prevention Magazine inc:

Morgaine

A new light at the end of the tunnel:

Dissatisfied with the treatments currently available to people with this painful nerve problem, researchers at the University of Vienna decided to see if ultrasound could help. They tested 34 people who had carpal tunnel syndrome in BOTH wrists (ouch!!) , applying real ultrasound (15 minutes a pop-every weekday for two weeks and then twice a week for an additional five) to one wrists and phony, “sham” ultrasound to the other.

The differences were amazing-by the second week, the wrists that got the real thing were much less painful, had regained much of the sensation previously lost to the conditional and had improved grip strength in that hand. More importantly, these improvements were still present six months after the treatments had ended. At that six month follow-up, a whopping 74% (22 of 30) of the treated wrists were judged by their owners to be completely cured or “improved satisfactorily,” versus just 20% (6 of 30) of the wrists that got the phony treatment (British Medical Journal: March 7 98)


I think this is the original article that the Natural Healing piece was based on. There are also links to related correspondence. Unfortunately it all seems to refer only to general CTS, and not pregnancy-induced CTS, which is usually transient. This means that there is lots of depressing stuff about how the only real ‘cure’ is surgery!

Ultrasound treatment for treating the carpal tunnel syndrome: randomised “sham” controlled trial

BMJ 1998;316:731-735 ( 7 March )
Ebenbichler et al., University of Vienna, Department of Neurology

Objective: To assess the efficacy of ultrasound treatment for mild to moderate idiopathic carpal tunnel syndrome.

Design: Randomised, double blind, “sham” controlled trial with assessments at baseline, after 2 weeks’ and 7 weeks’ treatment, and at a follow up assessment 6 months later (8 months after baseline evaluation). Setting: Outpatient clinic of a university department of physical medicine and rehabilitation in Vienna.

Subjects: 45 patients with mild to moderate bilateral carpal tunnel syndrome as verified by electroneurography.

Intervention: 20 sessions of ultrasound (active) treatment (1 MHz, 1.0 W/cm2, pulsed mode 1:4, 15 minutes per session) applied to the area over the carpal tunnel of one wrist, and indistinguishable sham ultrasound treatment applied to the other. The first 10 treatments were performed daily (5 sessions/week); 10 further treatments were twice weekly for 5 weeks.

Main outcome measures: Score of subjective symptom ratings assessed by visual analogue scale; electroneurographic measures (for example, motor distal latency and sensory antidromic nerve conduction velocity). Results: Improvement was significantly more pronounced in actively treated than in sham treated wrists for both subjective symptoms (P< 0.001, paired t test) and electroneurographic variables (motor distal latency P< 0.001, paired t test; sensory antidromic nerve conduction velocity P< 0.001, paired t test). Effects were sustained at 6 months’ follow up.

Conclusion: Results suggest there are satisfying short to medium term effects due to ultrasound treatment in patients with mild to moderate idiopathic carpal tunnel syndrome. Findings need to be confirmed, and ultrasound treatment will have to be compared with standard conservative and invasive treatment options.

Key messages

Chronic entrapment of the median nerve at the wrist (the carpal tunnel syndrome) is probably the most common peripheral nerve lesion

No satisfactory conservative treatment is available at present

Twenty sessions of ultrasound treatment show good short and medium term efficacy in patients with bilateral, mild to moderate forms of the carpal tunnel syndrome

Optimal treatment schedules of ultrasound treatment alone or in combination with other non-surgical treatments await elucidation

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Another article found that steroid injections into the area helped in the short-term, but presumably you’d want to avoid this in pregnancy:

http://www.bmj.com/cgi/content/abstract/319/7214/884

AH updated 5 October 2000

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