Common Conditions Of The Hand 
During Pregnancy and Motherhood

By Christine Khelfa, OTR/L, CHT, Triplet Mom
Originally printed in April 2003

Along with the joys of pregnancy comes a variety of symptoms - from feeling the first 
kicks to morning sickness.  In addition to these symptoms are common conditions of the 
hand and wrist.  These can leave the mother-to-be and new moms with pain, discomfort 
and often times, limited ability to use the affected hand.  The following are a few of the 
more common conditions, their symptoms and their treatments.

CARPAL TUNNEL SYNDROME (CTS):
Probably one of the most common diagnoses, its classic symptoms are numbness and 
tingling in the fingers.  It is caused by compression of the median nerve at the wrist.  
When there is an increase in fluid/swelling in the body, compression of the nerve occurs 
and one experiences symptoms.  This nerve supplies sensation to the thumb, index, 
middle and ½ of the ring fingers.  People with this condition often complain of pins and 
needles or feeling like their hand is asleep.  Pain is another symptom.  Symptoms can 
occur at night, only with activity or all the time.  At this point, people will complain of 
inability to fasten buttons, difficulty writing and frequent dropping of small items, such 
as change.  In most cases, CTS is reversible and when it is pregnancy related, often 
resolves once the babies are born.  However, this is not always the case.  Some people are 
also more prone to CTS although why, this is so is uncertain.  The extensive swelling that 
occurs during pregnancy, especially with multiples, is one factor.  The anatomy of an 
individual is another.  A person's activity may also contribute to the development of CTS 
as certain tasks involving the hands have been known to exacerbate symptoms.  If one 
were to think about the activities a mother of multiples performs over 24 hours, it 
becomes easy to understand why symptoms do not always resolve once the pregnancy is 
over.  Holding the babies in awkward positions for feeding and nursing, repetitive lifting 
of the babies, bottle washing and transporting the babies in their carriers are just a few of 
the tasks, performed over and over, that can cause symptoms to continue.  So what is a 
person to do?  First and foremost is to discuss all symptoms with your doctor.  He/She 
may then provide you with a splint or refer you to an occupational therapist who can 
fabricate a custom splint for your wrist and provide education in activity modification.  
The splint takes compression off the nerve and if worn for several weeks will allow 
symptoms to subside.  It is important that the splint puts the wrist in a neutral, or straight, 
position.  Store bought splints worn right from the box actually put the wrist in extension, 
which does not decompress the nerve; therefore symptoms may not subside despite 
usage.  If, despite use of a splint and activity modification, symptoms continue or are so 
severe that function is impaired, the optimal next step would be consultation with a hand 
surgeon or certified hand therapist (CHT) who is specialized in identification and 
treatment of these problems.  The hand is such a complex structure that problems often 
overlap and can be difficult to diagnose and treat.  The therapist (OT or PT) can also help 
identify causative factors and recommend different positioning techniques to help 
decrease symptoms.

DEQUERVAIN'S TENOSYNOVITIS:
This is another common hand/wrist problem occurring in pregnancy and more so in 
motherhood.  It is actually nicknamed "New Mother's Disease."  Symptoms include pain 
and swelling over the radial (thumb) side of the wrist.  Pain is often exacerbated by 
activity but in severe cases can be present at all times.  Pain can extend into the thumb 
and is most prominent when curling the thumb under the four other fingers and then 
turning your wrist towards your pinky.  This maneuver, called a Finkelstein's Test, is 
used to diagnose this disorder.  DeQuervain's is actually caused by inflammation of the 
sheath surrounding two tendons that run along the wrist.  It is often caused by repetitive 
lifting and carrying of objects (i.e. baby carriers and babies themselves!) but can also 
occur when the thumb and wrist are held in an extended position for long periods of time.  
An example would be the position of the hand and thumb as it supports an infant's head 
while nursing or bottle feeding.

The optimal treatment for DeQuervain's is a custom made splint that immobilizes the 
wrist and a portion of the thumb.  If one wears a store bought splint that does not include 
the thumb, symptoms will most likely continue and can even worsen as the edge of the 
splint rubs against the inflamed wrist area.  The custom splint provides absolute rest to 
the tendons, which is exactly what they need.  It is next to impossible to rest without a 
splint because even an activity as simple as holding and reading a newspaper will 
continue to aggravate the condition (and we all know that the amount of activity a mother 
of multiples performs daily is significantly greater than reading a newspaper - who has 
time for that?).  Things like pushing a twin or triple stroller, carrying multiple items at the 
same time and lifting a baby out of a car seat, especially as he/she gets heavier, can often 
be excruciating to a person with this condition.  The use of the splint can actually make 
these tasks a little more bearable while allowing the inflammation to subside.  The splint 
needs to be worn as much as possible (even at night) but when baby care necessitates the 
removal of it, alternating the way the hand is positioned may help.  Examples include the 
use of a Boppy pillow for nursing/feeding and lifting your babies by scooping your hand 
under their bottom while supporting their back with your other hand instead of lifting the 
baby under the arms.

A simple way to identify activities that aggravate this condition is to note when your 
symptoms are most severe and then think about what you are doing at that moment or 
prior to it.  Ice is also helpful in decreasing the pain.  Taking a bag of frozen peas out of 
the freezer and placing it over your wrist for 20 minutes will help.  When time is an issue, 
take an ice cube and massage directly over the sore area for no longer than five minutes.  
This can be done several times a day.

When a splint is used, symptoms often take about six weeks to resolve; so again, be 
diligent and wear your splint!  The more severe your symptoms are and the more present 
they are during the day, the longer it will take them to resolve so early treatment is the 
key. Most mothers are so busy they wait until the symptoms are severe before seeking 
treatment.  This will necessitate longer splint use and occasionally visits to the therapist 
2-3 times a week for further treatment.  I know we all want to get out of the house but the 
mall would probably be more fun than the hospital!

CUBITAL TUNNEL SYNDROME:
Worth mentioning briefly is another condition of the hand that is not as common as CTS 
and DeQuervain's but is often misdiagnosed.  Cubital Tunnel Syndrome, or ulnar 
neuropathy, is caused by compression of the ulnar nerve at the elbow.  Symptoms include 
numbness and tingling in the ring and small fingers.  Soreness at the elbow may also be 
present.  Hitting your "funny bone" involves this nerve and causes brief but similar 
symptoms.  Activities that aggravate these symptoms include leaning on your elbows 
(especially on a hard surface like a rocking chair) and holding your elbow in extreme 
flexion for prolonged periods of time (such as when talking on the phone).  Symptoms 
may occur only at night as most people sleep with their arms flexed, causing compression 
of the inflamed nerve for several hours (if your babies are sleeping!).  Treatment  for this 
is use of a night splint that keeps the elbow somewhat straight.  Activity modification can 
also help.  Ideas include the use of an elbow pad or blanket around the arms of a rocking 
chair and a headset for your phone.

When seeking out help for these or any problems involving your hands/arms, remember 
the following tips:

1.	Get help early- don't wait for severe pain and limited function to discuss 
symptoms with your doctor.  The earlier the condition is treated, the quicker it 
will go away.
2.	Try to keep track of specifically where you feel symptoms and when they occur.  
This will help your doctor or therapist identify and treat your problem.
3.	Try to follow your splint use guidelines as much as possible.  Symptoms will 
continue to linger if the splint is only worn part of the time.
4.	Most problems do go away with proper treatment.  You don't have to live with 
the pain.