Carpal Tunnel Syndrome (CTS) during pregnancy is more common than general CTS [1, 2]. Symptoms such as numbness, tingling and often appear in the third trimester, yet it has been reported in the first and second trimesters [3].
Anatomy, other causes, assessment, signs and symptoms are in another page the link just below.
Risk factors [2, 3, 4].
· Diabetes
· Hypertension
· Rheumatoid arthritis (RA)
· Previous pregnancy
· Previous history of CTS
· Hypothyroidism
· Higher BMI (>27.5) at the start of the pregnancy
· Greater weight gain (>18kg)
· Depression
· Requires the prenatal care or management (>10 treatments)
· Higher levels of education due to sedentary work?
· Higher fluid retention (have to remove a ring due to oedema)
*Study showed that BMI 18-24, which is normal, has a higher percentage of CTS. However, this study did not clinically test to see if they have the CTS but only used subjective complaints and questionaries [4].
Treatment
· Splinting and bracing
· Activity modification
· Exercise
CTS in pregnancy is often restored after giving a birth. However, some people with CTS suffer from symptoms such as numbness, tingling and weakness 12 months postpartum [10].
Exercise recommendations for pregnant women
A recent systematic review reported exercise recommendations and contraindications for pregnant women [5]. Fig3, is examples of exercise intensity based on METs. 23 METs included 4 sport activities should be performed for a week for the health promotion. This is for the general people not for pregnant women [6].
| Frequency | Most days of the week |
| Intensity | Moderate intensity (RPE12-14), subjective reported exercise intensity quantified from 6-20. (20 is the maximum intensity) |
| Time | 30mins per session, 150 mins per week |
| Type | ·Aerobic: walking, swimming, cycling ·Resistance training: compound (targeting multi-joint) body weight, light weight ·Stretching ·Proprioception exercise (balance exercise, yoga etc..) |
| Absolute contraindications | Relative contraindications | Advised to avoid |
| Serious heart disease | Symptomatic anaemia | Contact sports |
| Restrictive lung disease | Extreme morbid obesity | Facing down after first trimester |
| Uncontrolled hypertension | Underweight BMI< 12 | Excessive heat |
| Sudden increase in blood pressure after 20 weeks | Moderate cardiovascular, respiratory diseases | Risk of falling and loss of balance |
| Premature labour | History of preterm birth | Scuba diving |
| Incompetent cervix | Malnutrition, eating disorder | High altitude (climbing mountains) |
| Multiple gestation (having twins) | Unevaluated maternal irregular heartbeat | Abdominal trauma |
| Unknown vaginal bleeding | Horse riding | |
| Uncontrolled thyroid and diabetes diseases |
Exercises and physical activities have some positive effects
Exercises help not only the pregnant women but also the babies.
Some research reported that exercises pre and during pregnancy have a upward effect on postpartum weight gain, Caesarean birth and a baby with low birth weight [5, 8]. However, not may pregnant women engage in exercises and physical activities during pregnancy despite these positive effects. The reasons behind this issue are because pregnant women do not receive the exercise and physical activity advice, health care providers do not have confidence to prescribe and give an advise on exercise and there is not enough support for the women [5, 8, 9].
Are these achievable for your patients?
We know that exercise and physical activity is vital for us to be healthy. Exercise recommendation says that 150-300minutes of aerobic exercise and resistance training 2-3 times a week are recommended [7]. Also, 23METs including 4METs of sports activity from fig3 are recommended in the Japanese guideline for health promotion [6]. If you work full-time with some extra work every day, it is not easy to achieve this target. Exercises do not have to be an actual sport or exercise. It can be like walking to the station instead of driving, using stairs instead of using an escalator or a lift if you do not have some time to exercise. If you can keep on doing the exercises whatever you enjoy, that is the most important thing.
Conclusion
Exercises or physical activities should be performed or maintained pre and during pregnancy if they do not have contraindications. As the obesity, high BMI and diabetes are risk factors for CTS in pregnancy, exercises to manage weights may help symptoms of CTS.
References
[1] Weimer, L. H., Yin, J., Lovelace, R. E., & Gooch, C. L. (2002). Serial studies of carpal tunnel syndrome during and after pregnancy. Muscle & Nerve, 25(6), 914–917. https://doi.org/10.1002/mus.10126
[2] Wright, C., Smith, B., Wright, S., Weiner, M., Wright, K., & Rubin, D. (2014). Who develops carpal tunnel syndrome during pregnancy: An analysis of obesity, gestational weight gain, and parity. Obstetric Medicine, 7(2), 90–94. https://doi.org/10.1177/1753495×14523407
[3] Yazdanpanah, P., Aramesh, S., Mousavidazeh, A., Ghaffari, P., Khosravi, Z., & Khademi, A. (2012). Prevalence and Severity of Carpal Tunnel Syndrome in Women. Iranian Journal of Public Health, 41(2), 105–110. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3481675/
[4] Meems, M., Truijens, S., Spek, V., Visser, L., & Pop, V. (2015). Prevalence, course and determinants of carpal tunnel syndrome symptoms during pregnancy: a prospective study. BJOG: An International Journal of Obstetrics & Gynaecology, 122(8), 1112–1118. https://doi.org/10.1111/1471-0528.13360
[5] Rudin, L. R., Dunn, L., Lyons, K., Livingston, J., Waring, M. E., & Pescatello, L. S. (2021). Professional Exercise Recommendations for Healthy Women Who Are Pregnant: A Systematic Review. Women’s Health Reports, 2(1), 400–412. https://doi.org/10.1089/whr.2021.0077
[6] Tabata, I. (2007). Exercise and physical activity guide for health promotion 2006. -to prevent lifestyle-related diseases-. https://www.nibiohn.go.jp/eiken/programs/pdf/exercise_guide.pdf
[7] Yang, Y. J. (2019). An Overview of Current Physical Activity Recommendations in Primary Care. Korean Journal of Family Medicine, 40(3), 135–142. https://doi.org/10.4082/kjfm.19.0038
[8] Szumilewicz, A., Worska, A., Rajkowska, N., & Santos-Rocha, R. (2015). Summary of Guidelines for Exercise in Pregnancy–are they Comprehensive Enough for Designing the Contents of a Prenatal Exercise Program? Current Women s Health Reviews, 11(1), 3–12. https://doi.org/10.2174/157340481101150914200838
[9] Ahmadi K, Amiri-Farahani L, Haghani S, et al. Exploring the intensity, barriers and correlates of physical activity In Iranian pregnant women: a crosssectional study. BMJ Open Sport & Exercise Medicine 2021;7:e001020. doi:10.1136/ bmjsem-2020-001020
[10] Meems, M., Truijens, S. E., Spek, V., Visser, L. H., & Pop, V. J. (2017). Follow-up of pregnancy-related carpal tunnel syndrome symptoms at 12 months postpartum: A prospective study. European Journal of Obstetrics & Gynecology and Reproductive Biology, 211, 231–232. https://doi.org/10.1016/j.ejogrb.2017.02.030
