After pregnancy is over and care of the beautiful, new baby begins, the day and night activity of the new mother changes dramatically. While aches and pains associated with pregnancy may have waned, I frequently see these women in the office complaining of pain and tingling in the wrist or hand that evolves in the early weeks following delivery. While caring for their infant, they experience significant pain that can put a very real damper on those early weeks at home with baby.
The body does not get a free pass when it comes to pregnancy. A hormone called relaxin is produced beginning in about the sixth week of pregnancy, and it continues to be produced until after delivery. Relaxin serves to relax the ligaments that constrain the pelvis – ultimately providing for that extra stretch that will accommodate the growth and ultimate delivery of the baby. In addition, a significant amount of additional blood volume is manufactured to provide nourishment for the growing fetus, and that additional volume and related shifting of fluids accounts for the swelling in feet and hands that plague many pregnant women.
A very common complaint is pain in the wrist and numbness/tingling in the thumb, index and middle fingers. My patient will often say that the pain is worse at night – often waking her from sleep and depriving her of the precious little sleep that she’s able to get as a new parent. Carpal tunnel syndrome, or swelling of the band-like structure at the wrist that covers the median nerve, is a condition in which the additional body fluid associated with pregnancy compresses the nerve that provides sensation to the thumb, index, middle finger and half of the fourth. Symptoms can occur when the hand is in one place for a long period of time and in a flexed position – such as when carrying an infant.
Early on, symptoms can often be relieved with simple treatments like wearing a wrist splint. While anti-inflammatories like Ibuprofen can be helpful in relieving pain and reducing swelling, many of the patients I see are breastfeeding and unable to use these medications. If left untreated, carpal tunnel can result in permanent numbness and weakness in the hand. Fortunately, for most women that experience this condition during or after pregnancy, the situation resolves as body fluids and hormones return to a pre-pregnancy state. Sometimes my patients will continue to have symptoms despite use of a splint and the passage of time. In those patients, I may offer a cortisone injection into the wrist to deliver the medication directly to the inflamed, swollen tissue that is compressing the nerve.
Another variation on wrist pain in women who are pregnant or who have recently delivered is something called DeQuervain’s tenosynovitis. It refers to tendons around the base of the thumb that are irritated or compressed due to swelling associated with pregnancy-related fluid or hormone changes or due to overuse associated with childcare – such as cradling the infant in one arm while using the other hand to accomplish the many “one-handed” tasks that mothers must perform. My patients will usually complain that they have pain in the wrist with movement of their thumb, and they become acutely aware of how much they use their opposable thumb. Treatment closely mirrors that provided for carpal tunnel with the use of a splint that immobilizes not only the wrist, but the thumb as well and in more chronic cases a cortisone injection can be helpful.
The birth of a child is a time for celebration, and associated wrist pain can come as an unwelcome surprise. Simple, conservative treatment is available and can return the mother to caring for her child without discomfort. Whoever thought that “rocking the cradle “ could be orthopedically hazardous?