Carpal Tunnel Syndrome in Lactation: A Challenging Issue

Abstract

Context: Carpal tunnel syndrome (CTS) is a prevalent complaint during pregnancy and lactation. During lactation both environment and hormonal changes can contribute to worsening the symptoms. Some authors believe that CTS in lactation is a separate clinical entity which develops in pregnancy. Therefore, the specific conditions of these patients demand a special assessment of their treatment. Evidence Acquisition: We searched Pubmed, Scopus and Google Scholar regardless of the articles' publication date. The search was performed using the terms "carpal tunnel syndrome", "median nerve entrapment" or "median nerve neuropathy" which were independently associated (by using "and" in the builder) with breastfeeding, lactation, nursing, postnatal, postpartum, puerperal, and puerperium. We restricted our search to the articles published in English or Persian. The abstracts of references were carefully reviewed and included, if related to CTS and lactation. Finally, the extracted data about therapeutic options available for mothers during breastfeeding were assigned to different areas such as surgical, medical, etc. Related articles were then discussed under the most appropriate topics. Results: Usually, gradual resolution of the symptoms of CTS occurs after stopping breastfeeding. Reassurance and nursing advice on optimal positions for holding baby and breasts during breastfeeding is the first step of treatment. Intra-carpal steroid injection, diuretics and non-steroidal anti-inflammatory drugs might have some benefits, according to the few observational studies on lactating women with CTS. Splinting as a safe option that does not interfere with breastfeeding with good efficacy is suggested by all authors. Surgical intervention is spared for the patients experiencing severe symptoms for long periods, those with thenar muscles wasting or when conservative treatment fails. Conclusions: Current evidence suggests that in addition to nursing advice regarding positioning during breastfeeding, similar treatment strategy for CTS in general population is suitable for lactating mothers. However, available studies suffer from many shortcomings and have not evaluated all therapeutic options in this field. Well-designed interventional studies with special focus on this issue are needed to provide evidence based recommendations.

Pulsed magnetic field versus ultrasound in the treatment of postnatal carpal tunnel syndrome: A randomized controlled trial in the women of an Egyptian population

“…Surgery is reserved for patients with severe CTS, and those who have experienced failure of conservative treatment. The same treatment strategy is used for postnatal patients with CTS [12].…”

Incidental Trifid Median Nerve Unveiled in a Lactating Mother

“…The resultant clinical manifestations could be better explained by fluid retention, hormonal fluctuations, nerve hypersensitivity, glucose level fluctuation, etc. [11,12]. As the individual in the present study was already on postnatal care, the fluid retention hypothesis cannot fully explain the CTS manifestations.…”

“…Alongside some above mentioned clinical features, the present study further differs from the previous cases based on the breastfeeding status. Pregnancy and breast-feeding are associated with increased CTS prevalence [11,12]. The resultant clinical manifestations could be better explained by fluid retention, hormonal fluctuations, nerve hypersensitivity, glucose level fluctuation, etc.…”

“…Carpal tunnel syndrome in breastfeeding women can be treated using the following interventions - oral anti-inflammatory drugs, vitamin-B combination, diuretics, intralesional steroid injection, splinting, local ultrasound and laser therapy, however, sometimes, surgical exploration of the carpal tunnel is required to release the compressed median nerve [12]. Here we treated the condition with diclofenac potassium and the focal ultrasound therapy over the flexor retinaculum.…”

“…Here we treated the condition with diclofenac potassium and the focal ultrasound therapy over the flexor retinaculum. Further training on how to adopt side-lying and foot-ball hold position during baby care was also provided and seemed to be effective [12].…”