CTS in pregnancy

Although CTS is extremely common during pregnancy there is surprisingly little scientific literature devoted to it. The topic has been comprehensively reviewed by the Italian CTS study group (Padua 2010)

CTS symptoms tend to occur in the latter part of pregnancy and are widely attributed to 'fluid retention' though there seems to be no concrete evidence that this is actually the mechanism of an increase in pressure in the carpal tunnel during pregnancy. It seems at least equally likely that it is the change in the internal hormonal environment during pregnancy which predisposes to CTS.

It is also widely believed by obstetricians and midwives that the problem will almost always go away after delivery of the baby. Studies by the Italian group (Padua 2001, Padua 2002) suggest that this may be a more optimistic view than is warranted with perhaps 50% of patients still having symptoms 1 year after delivery and 30% 3 years after delivery.

There also appears to be a small group of women in whom symptoms of CTS begin, not during the pregnancy itself but shortly afterwards, often while breast feeding and it is possible that this group again have symptoms precipitated by a sudden change in hormonal status, perhaps exacerbated by a change in habitual physical activity associated with caring for a newborn. This group of patients, anecdotally, are less likely to experience spontaneous remission of symptoms but this topic needs further study.

Pre-existing carpal tunnel syndrome is likely to be exacerbated by becoming pregnant, but again there is no formal study available to prove this.

It is not known for certain whether getting CTS in one pregnancy increases the risk of experiencing the same problem again with a subsequent pregnancy, nor is it known whether women who experience CTS during pregnancy are at higher risk of developing CTS in later life.

Treatment with splints is safe at any time. Steroid injection can be used safely in later pregnancy and during lactation. Occasionally surgery is needed even during a pregnancy if there appears to be a risk of developing irreversible nerve damage.

Revision date 24th February 2012

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