Carpal tunnel syndrome in pregnancy
Definition of carpal tunnel syndrome
Under the term "Carpal tunnel syndrome“One understands a disease in which there is to Narrowing of the median nerve (Median nerve) in the area of the wrist.
Of the Carpal tunnel is a narrow space that between the Carpal bones and the one above Carpal band (Ligamentum transversum; Retinaculum flexorum) lies. Both the Tendons of various muscles, as well as the Median nerve. The symptoms typical for the presence of carpal tunnel syndrome can be explained by the functions of this nerve.
Above all, the sensitivity of the thumb, index and middle finger is conveyed through these nerves. In addition, the nerve impaired by the carpal tunnel syndrome is used to control various hand and finger muscles.Direct damage to this nerve in the course of compression consequently leads to limitations in sensitivity, numbness and restricted movement of the fingers.
Furthermore, the nocturnal occurrence of tingling is one of the first signs of the presence of the carpal tunnel syndrome. In the further course, the affected patients also develop pain when grasping.
The Carpal tunnel syndrome is characterized by damage to the median nerve in the area of the wrist, even during pregnancy.
In general, carpal tunnel syndrome also belongs to the pregnancy most common compression syndromes. Are particularly at risk elderly, in which Women about three to four times more often are affected as men.
Since the long-term blockage of the median nerve in the carpal tunnel can cause permanent damage, carpal tunnel syndrome should be treated promptly. As a rule, treatment is also carried out during pregnancy by the nocturnal immobilization of the affected wrist. In many cases, this simple measure alone brings relief to the patient.
For further Therapeutic measures for a carpal tunnel syndrome (For example, local cortisone injection or surgical cleavage of the retinaculum), special guidelines must be observed during pregnancy.
The real one The cause of the development of a carpal tunnel syndrome lies in one unfavorable relationship between the Carpal tunnel and the roomthat the structures running in it actually need. Due to the limitations of the carpal tunnel, this is Space severely limited.
If it comes to one increase the one prevailing in the carpal tunnel Pressure become the vessels running in it and the median nerve compressed. Especially the Nutrition and oxygen supply the median nerves are severely affected in this way. In the long run, this can lead to the individual Nerve fiber damage and can no longer exercise their function. Feel the affected patient tingling sensation at night, Loss of sensitivity and Pain.
The usual risk factors can also contribute to the development of carpal tunnel syndrome during pregnancy. Among the most important Risk factors belong:
- Constitutional narrowing of the carpal tunnel (for example through certain variants of a carpal bone)
- Inflammatory processes in the area of the tendon sheaths
- Swelling of the tendon sheaths (especially common during pregnancy, rheumatic diseases or due to excessive stress)
- Fractions in the area of the radius or carpal bone
- arthrosis in the wrist
- Space-consuming processes in the area of the wrist (e.g. tumors)
In addition, special influencing factors can lead to the development of carpal tunnel syndrome during pregnancy. In this context, the most important hormonal changes a crucial role. Just in last third During pregnancy, the mother-to-be's body tends to increase Store liquid. This means that there is also an increased fluid content inside the carpal tunnel. If the carpal tunnel is relatively narrow before pregnancy due to its individual shape, the increasing fluid content can lead to the development of carpal tunnel syndrome.
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As a rule, the carpal tunnel syndrome occurs during pregnancy at the beginning of the disease Pain or tingling fingers noticeable. in the Initial stage However, these symptoms subside after a short time.
Typical for the presence of the carpal tunnel syndrome are above all during the night Occurring pain and tingling paresthesia (fingers tingling). In the further course, both the duration and the intensity of the symptoms felt by the patient concerned increase. In most cases, those affected indicate Suffering pain in the area of the wrist, thumb, index and middle finger that radiate into the arm. Typically, the symptoms caused by carpal tunnel syndrome can also pass through pregnancy Rubbing or shaking hands is alleviated become.
Is the carpal tunnel syndrome already further advanced, the discomfort occurs on the affected hand no longer temporarily on. Most of the affected patients feel this is advanced permanent discomfort. In addition, the pronounced damage to the median nerve can lead to the feeling that the patient has received an electric shock when performing grasping movements. Furthermore, the functionality of the nerves decreases significantly in the further course of the carpal tunnel syndrome. Thumb, forefinger and parts of the middle finger are usually perfect callous (Sensory disorder). In addition, the patient is typical Not more able to do so with the affected hand fine motor activities exercise.
The Late stage carpal tunnel syndrome is also characterized by one during pregnancy significant decrease in the lateral muscles of the ball of the thumb out (ball of the thumb atrophy). This muscle wasting usually results in a Splay- respectively Flexion weakness of the thumb and an accompanying Loss of strength with gripping movements.
The diagnosis of carpal tunnel syndrome during pregnancy is also divided into several steps. Already during the doctor-patient conversation (anamnese) The description of the perceived complaints can be one first hint for the presence of carpal tunnel syndrome. This suspected diagnosis can then be corroborated by further measures.
Must during an indicative physical exam both hands in comparison be assessed. The doctor pays particular attention to this in this step visible abnormalities like for example Redness, Swelling, Bruising and or Injuries. Afterwards, both the mobility of the hand and fingers and their sensitivity can be checked with various test methods.
In addition, various belong Provocation tests even during pregnancy for the standard diagnosis of carpal tunnel syndrome. During these tests, the doctor tries to determine whether carpal tunnel syndrome is present provoke typical pain. So knocked For example, he uses the carpal tunnel to check whether a irritation of the median nerve is present. In addition, a persistent strong flexion of the wrist lead to the symptoms typical of carpal syndrome.
A electrophysiological examination can also be carried out without hesitation during pregnancy. This method can help to secure the diagnosis of "carpal tunnel syndrome" and to estimate the extent of the disease. During this investigation, the Nerve conduction velocity, i.e. the time it takes for the median nerve to transmit a defined stimulus. A Humiliation the nerve conduction velocity is indicative of the presence of a pronounced carpal tunnel syndrome typical.
In some cases, additional imaging procedures to be necessary. During pregnancy, the preparation of radiological, computed resonance tomography and magnetic resonance imaging if possible avoided become. Because of this, performing a Ultrasound examination help to secure the diagnosis of "carpal tunnel syndrome", especially during pregnancy.
In addition, the so-called "Electromyography“(Short: EMG) as the measurement of the electrical activity in those supplied by the nerves Muscles in the area of the ball of the thumb, is an important method in the diagnosis of carpal tunnel syndrome. This examination method can, if necessary, also be carried out during pregnancy.
Generally one is treatment of the carpal tunnel is always necessary when the complaints are particularly severe frequently occur or over a longer period stop. In this context, however, it should always be borne in mind that any risk to the unborn child should be excluded during pregnancy.
If the carpal tunnel syndrome is mild during pregnancy, a special wrist splint be prescribed especially during the night should be worn. In addition, the careful cooling of the affected wrist help relieve the discomfort.
Particularly pronounced cases of carpal tunnel syndrome are diagnosed outside of pregnancy with the help of a surgical intervention treated. During this procedure that will Flexor retinaculum split and thus the space inside the carpal tunnel is expanded. During pregnancy, on the other hand, this surgical procedure should only be performed if there are excruciating symptoms. The meanwhile existing modern anesthetic procedures (for example the so-called "plexus anesthesia") enable Carpal tunnel syndrome surgery carried out with an acceptable risk for mother and child.
Although an operative treatment of the carpal tunnel syndrome is possible during pregnancy, the women concerned should always bear in mind that the symptoms can completely regress after childbirth.
Please also read: Carpal tunnel syndrome surgery
One can assume that with about 50 percentwho suffered from carpal tunnel syndrome during pregnancy Symptoms completely disappearas soon as the child delivered and the body and its hormonal balance have changed again.
During the pregnancy it comes to one particularly often Carpal tunnel syndrome. This is particularly frustrating for the affected mothers, as they often cannot hold or stroke their child after the birth due to the pain. But why is carpal tunnel syndrome so common in pregnancy?
During pregnancy, the female body is subject to a large one Variety of hormonal changes. Among other things, these lead to increased water in the tissue is stored. Therefore, there is also a significant one during pregnancy Weight gain, and Swelling of the limbs.
This water is now in the tissue, and there presses on the surrounding structures. Also, or especially in wrist water accumulates because the wrist is furthest away from the trunk and the water literally runs into the hands.
This in turn leads to constriction, that is compression, of Median nervewho is responsible for the sensitive and motorized supply of large parts of the hand. The result is the carpal tunnel syndrome. The good news, however, is that with the Normalization of the hormonal balance also the Water retention decreases, and pain and numbness soon go away.