Pain in Pregnancy Part 6: Wrist Pain and Carpal Tunnel

Wrist and hand pain, often caused by compression at the carpal tunnel is very common during pregnancy. It's estimated that up to 62% of pregnant individuals will experience carpal tunnel symptoms!

What causes carpal tunnel and wrist/hand pain during pregnancy?

1. Increased fluid volume - swelling in the wrist and hand can compress on the median nerve that runs through the carpal tunnel, leading to pain and numbness/tingling.

2. Hormonal changes - relaxin and progesterone both can increase mobility, leading to slightly less stability.

3. Postural changes - while not the main factor, having a more "forward head position" and tightness through the chest and back can lead to further compression to the other end of the nerve.

Anatomy Review

The nerves from between the C5 and T1 (C5 = 5th vertebra in the neck, T1 = 1st vertebra in the mid back) form part of the brachial plexus. That is a bundle of nerves that goes under your 1st rib, under the pec muscle, and down into the arm. The brachial plexus splits at the wrist to three different nerves. For carpal tunnel syndrome, we are focused on the median nerve. The carpal tunnel is located in the wrist. The median nerve passed through that tunnel and sends signals to parts of your hand. The median nerve gives sensation to the palm side of your hand, specifically the thumb, pointer, middle, and half of the ring fingers.

What do I do to relieve wrist and hand pain during pregnancy?

I’ll always recommend physical therapy for any pains during pregnancy. Improving mobility can help improve pain, and learning about posture, movement, and positioning are all things to help keep it at bay. A lot of what we do is figuring out if that median nerve is being compressed in other spots as well.

1. Specific stretching: depending on what specifically is happening to you, certain stretches can be wildly helpful. 

   1. Example: Doorway pec stretch: simply stretching the pectoralis muscles can help reduce compression on the brachial plexus (the bundle of nerves that eventually splits to become the median nerve). I suggest holding at least 30 seconds, but ideally closer to 2 mins.

2. Specific strengthening: again, specific to your individual case, there are a variety of strengthening exercises that can help reduce your rib pain. 

   1. Example: Neck strengthening exercises: giving you more stability at the neck can also decrease the compression around where the nerve originates.

3. Posture: making adjustments to how you are sitting, standing, and moving can change tension and compression on the nerves.

4. Positioning in sitting and in bed: using pillows, blankets, and towels to support your body when laying or sitting can also help deload areas of discomfort. Rule of thumb is to fill in the gaps where your chair or bed doesn’t support. For example - placing a pillow under your belly when laying on your side can be a great way to decrease tension across the lower rib cage.

Red Flags for pain - when to seek medical attention:

Generally, wrist and hand pain is just pain, not a sign of something more serious. However, if you have any of the following symptoms, you should seek immediate medical counsel from your doctor. They can be symptoms of more serious conditions!

• Sudden, severe pain under the right rib cage.

• Pain under the right rib that is persistent or worsens and is accompanied by:

  • Severe headache

  • Vision changes (like spots or blurred vision)

  • Nausea and/or vomiting

  • Sudden swelling of the face and hands

  • High blood pressure

• Pain accompanied by fever, chills, or pain in the back (which could indicate a Urinary Tract Infection/kidney infection).

Contact your health care provided right away if you have symptoms like:

• Vaginal bleeding or fluid leakage

• Fever

• Burning sensation when urinating

• Numbness, tingling, or weakness in the legs, buttocks, or genitals

• Intense, sudden, or cyclical pain (which could indicate contractions)

If you aren’t able to figure out how to relieve your pain, a PT can absolutely help! Physical therapists are experts in how the human body moves and functions, we can get to the root cause of your pain, and prescribe a specific program for you to work on. Additionally, we can actually work on you - improving muscle tone, joint mobility, and decreasing pain. 

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About the author: Dr. Caitlyn Hauswirth-Varis, PT, DPT, OCS, CFMT, CF-L1

Caitlyn is an expert in pelvic floor physical therapy, pregnancy and postpartum, and is board certified in orthopedic physical therapy. She has helped countless soon-to-be moms get out of pain during their pregnancy, and actually feel good throughout the process.

Disclaimer: This blog post is for informational purposes only and does not substitute for professional medical advice. Please consult with a qualified healthcare professional for personalized guidance.