What is Carpal Tunnel Syndrome?
The carpal tunnel is a passage through the palmar side of the wrist that contains tendons which lead to the thumb and fingers, as well as the medial nerve which innervates the thumb and first three fingers. Carpal tunnel syndrome results in pain, numbness, and tingling, caused by the entrapment and compression of the median nerve as it passes through the wrist. The longer this condition is left, the worse it will become, making early diagnosis and treatment crucial.
Carpal tunnel syndrome commonly occurs post pregnancy. During pregnancy a woman’s body will be subject to fluid retention. The increased fluid places a greater amount of pressure on the space within the carpal tunnel and the median nerve and tendons inside, therefore causing pain, irritation and neural symptoms such as numbness and tingling. Fluid retention during pregnancy is common and may lead to post pregnancy carpal tunnel syndrome even if fluid retention decreases after birth. Other factors which may be of influence are the presence of arthritis or a history of fractures and other structural changes to the carpal tunnel space.
How Does Being a Mother Affect Carpal Tunnel Syndrome?
Caring for a child is a demanding role which may put a lot of strain on a new mother’s body, which has already been weakened from both the pregnancy and birth of the child. Additional to the woman’s normal responsibilities which may include cooking, cleaning, and eventually returning to work, a new mother will spend time caring for her baby. These duties are typically done with the new mother holding the child in her arms and will make up a majority of a new mother’s day which means that there is constant weight bearing through the arms, hands, and wrist. Having a baby resting on the wrist puts a large amount of strain on the carpal tunnel area, resulting in tightening of the wrist muscles and exacerbating the symptoms of carpal tunnel syndrome. Even when feeding the baby the mother’s wrist can be placed in to an awkward bent position that is sustained until the baby has finished. When the baby is young it will require regular feeding therefore the wrist will be exposed to a harmful position frequently for prolonged periods of time, causing more pressure and increased damage on the carpal tunnel.
What Are the Symptoms of Carpal Tunnel Syndrome?
A new mother may experience numbness or tingling related to the compression of the median nerve in the wrist as it passes through the carpal tunnel. These sensations will be felt mainly in the thumb and the second, middle, and ring fingers. These fingers are innervated by the median nerve. Other symptoms may include a decrease in a new mother’s grip strength which may look like clumsiness, or frequently dropping items. The symptoms of carpal tunnel syndrome are increased at night but are present throughout the day and worse in activities which put strain on the wrist. These activities can be things a new mother will be required to do normally in her daily life such as driving, and are not restricted to caring for a baby.
How Is Carpal Tunnel Syndrome Managed By a Soft Tissue Occupational Therapist?
To determine the course of treatment for carpal tunnel syndrome, an assessment of the area will be completed, with consideration of the symptoms and medical history of the new mother. If caught in the early stages when there is a lower amount of pain and no irreversible damage present, adapting activities or wearing a splint during activities can help to ensure the wrist stays in a neutral position where there is low pressure placed on the carpal tunnel.
Carpal tunnel syndrome may be managed using conservative methods. A soft tissue occupational therapist can assist in a variety of ways. With the foundation knowledge of occupations (every activity you do in your day) and how they affect the and their body, an occupational therapist can provide suggestions and solutions on how to adapt an new mother’s environment or the way she completes activities to reduce strain and pressure on the carpal tunnel of the wrist. For example, a simple activity, such as typing at a computer at home or after returning to work, compresses the wrist and carpal tunnel area. The use of a gel cushion under the wrists when typing to lift the forearm and wrist will remove pressure created by leaning the arms on a table. A soft tissue occupational therapist has the background knowledge and creativity required to assist a new mother in finding a solutions to fix any activities which are increasing her pain.
Due to the relation between post-partum swelling and the increased pressure on the carpal tunnel, a soft tissue occupational therapist will also work on oedema management. One way in which they will do this is through developing range of motion exercises for the new mother to complete. The range of motion exercises will start with passively moving the wrist joint through its available range and then later when strength is increased the therapist will get the new mother to begin active range of motion exercises. Additional to range of motion exercises, the therapist will provide a stretch program for the new mother to complete as well as nerve and tendon glide exercises. The median nerve and tendons which pass through the carpal tunnel are compressed due to the pressure in the area and if they are not able to move freely, irreversible damage can be done. A soft tissue occupational therapist will provide step by step instruction on how to perform exercises which allow the median nerve and tendons to move smoothly through the wrist which helps to decrease swelling, improve range of motion of the joint, and decrease pain associated with carpal tunnel syndrome.
The occupational therapist will provide education to the new mother about the condition and give general tips on how to prevent further damage. Some of the strategies which may be suggested are: remembering to keep the wrist in a neutral position in daily activities by consciously reminding yourself, avoiding strenuous activities including carrying heavy baby bags, shopping, or laundry baskets, and soliciting help when available, and using a pillow to position the baby during feeding instead of carrying the baby’s weight through the wrist, causing less pressure on the carpal tunnel. Other activities which can be demanding on the wrist are those which require prolonged pinch or tight grips. Cooking is a prime example of this as the new mother will have to hold utensils with sustained pressure and move the wrist in awkward positions to stir, chop, and peel ingredients. If the new mother is unable to receive help with cooking, they should ensure they take regular rest breaks, switch hands when possible, or modify the way they cook. By buying pre-cut vegetables or by warming vegetables before chopping them, less pressure will be put on the wrist during food preparation.
Occupational Therapists will provide a variety of hands on treatment for new mothers diagnosed with carpal tunnel syndrome. Neuromuscular techniques will help to reduce pain experienced in the wrist and surrounding structures. This kind of therapy reduces spasming in muscles. When there is inflammation in the carpal tunnel post pregnancy, a new mothers wrist muscles begin to tighten. This in turn, creates more pain and inflammation. The role of the soft tissue occupational therapist is to locate the tight areas in the muscle and treat them until there is a full release of tension restoring the muscle to its normal healthy functioning, decreasing pain in doing so.
Urban Health’s Occupational Therapists also use trigger point dry needling or acupuncture. This treatment provided by a soft tissue occupational therapist works in a similar way to trigger point therapy in releasing the tension in a muscle, but instead of treating externally, a thin needle is inserted in the skin, in to the tight, irritable spot of the muscle. Trigger point dry needling is often used in conjunction with trigger point therapy and stretch and strengthening exercise programs to relieve the symptoms of carpal tunnel post pregnancy.
At Urban Health HQ our highly trained Soft Tissue Occupational Therapists will use a hands on approach to help treat your injuries, conditions or any concerns you may have. You can make an appointment today by calling 0411 563 391.