Common, and commonest late in pregnancyEmerging evidence
Wrist and hand pain is common in pregnancy and builds towards the end. In 184 Turkish women asked about pain in each trimester, hand and wrist pain affected 9.2% in the first trimester, 16.8% in the second and 29.3% in the third, and 33.2% at some point; only low back and back pain were commoner. Most of it is carpal tunnel syndrome: 59 of the same women (32.1%) reported its symptoms, 42 of them in both hands, and of 639 Dutch women followed through pregnancy, 219 (34%) reported symptoms, mostly mild to moderate and worse after 32 weeks.
Far fewer need a diagnosis or treatment. Carpal tunnel syndrome was diagnosed in 0.34% of pregnancies in records from Rochester, Minnesota, and in 2.8% of mothers in records from Pennsylvania, and in Malmö, Sweden, 56 of 2,358 women (2.3%) had symptoms that a hand surgeon examined. Symptoms are commonest in the third trimester (11%, 26% and 63% of cases by trimester in an Iranian clinic study), but they can start in any trimester, and in 7 of 30 French cases they started after the birth. A review adds that the nerve works less well late in pregnancy even in many women without symptoms.
Sources 1, 2, 3, 4, 5, 6, 7, 8
Why the figures vary so muchMixed evidence
How common it is depends on how it is counted. A review found that 31% to 62% of pregnant women were diagnosed from their symptoms and 7% to 43% on nerve tests; across 5 Iranian studies of 2,065 women, 10.5% met clinical criteria and 5.67% had it confirmed on nerve tests; and 23% of 482 women in the third trimester had its signs in one study. UK leaflets give figures of up to 50% or 60% without citing a UK study, and no UK study has measured it. The honest summary: about a third of pregnant women notice it, and far fewer need treatment.
Sources 9, 10, 11, 12, 13, 14
Carpal tunnel syndrome: how it feels, and why pregnancy brings it onStrong evidence
Carpal tunnel syndrome is pressure on the median nerve where it passes through a tunnel at the front of the wrist. It brings aching, numbness or tingling in the thumb, index and middle fingers, a weak thumb or a weaker grip, often starting slowly, coming and going and worse at night or first thing in the morning. Holding a phone, a book or a steering wheel with the wrist bent forwards can bring it on, NHS inform says. In pregnancy it is often in both hands (68% of the Rochester cases), and a pregnancy booklet adds swollen, hot hands and pain that can shoot up the arm as far as the shoulder.
NHS trust leaflets explain why pregnancy brings it on: the body holds extra fluid, and the swelling presses on the nerve in the tunnel. Outside pregnancy, pressure in the tunnel is lowest with the wrist close to straight and rises a lot when it bends forwards or back, which is why a splint keeps it straight at night. Pregnancy loosens the joints a little (wrist laxity rose in 19 of 35 women), but the change didn't track the levels of relaxin, oestrogen or progesterone, so loosened wrists aren't the explanation. Carpal tunnel syndrome can't harm your baby, an NHS trust leaflet says.
Sources 15, 16, 3, 17, 12, 18, 19, 20, 21, 22
Who is more likely to get it: links, not causesEmerging evidence
In studies, carpal tunnel symptoms in pregnancy went with more fluid retention and swelling (in the Dutch cohort, higher fluid-retention scores went with 1.8 times the odds), gaining more weight in pregnancy and a higher body weight, and gestational diabetes (1.4 times the odds of a diagnosis in the year after the birth, in US insurance claims). A first pregnancy was a link in Malmö and in Iranian studies, but more previous births was in a study from Pennsylvania. The NHS lists being pregnant among the things that make carpal tunnel syndrome more likely, alongside being overweight, arthritis and diabetes. These are links reported in studies, not causes, and none of it is anyone's fault.
Sources 2, 23, 4, 5, 24, 11, 25, 10, 15
Swelling: gradual is normal, sudden is a warning signStrong evidence
"It's normal to get some swelling in pregnancy, particularly in your legs, ankles, feet and fingers", the NHS says. It is often worse at the end of the day and further into pregnancy, rings can get tight, and swelling that comes on gradually is not usually harmful to you or your baby. But "A sudden increase in swelling can be a sign of pre-eclampsia or a type of blood clot called deep vein thrombosis (DVT) and needs to be checked immediately". The National Institute for Health and Care Excellence (NICE) lists sudden swelling of the face, hands or feet among the symptoms of pre-eclampsia that need checking straight away.
Pre-eclampsia complicates 2% to 8% of pregnancies worldwide. It is most likely from 20 weeks, can happen at any point in pregnancy and can start in the days or weeks after the birth. The NHS's current list of its symptoms is a severe headache that doesn't go away with simple painkillers, vision problems such as blurred vision or seeing flashing lights, pain below the ribs, sudden swelling of the face, hands or feet, feeling very unwell, heartburn that doesn't go away with heartburn medicines, and being sick.
Sources 26, 27, 28, 29, 30
After the birth: the thumb side of the wrist, and carpal tunnel while breastfeedingEmerging evidence
De Quervain's tenosynovitis, sometimes called mummy thumb, is pain on the thumb side of the wrist from the tendons that move the thumb, worse lifting with the thumb pointing up, as when lifting a baby, or gripping and turning the wrist. It is more common in the year after the birth: in US insurance claims it was diagnosed in 0.7% of 357,534 women in the year after giving birth, against 0.2% of similar women who hadn't, and in Korea in about 2.1% of 1.6 million women across pregnancy and the following year. When it starts is unsettled: US surgeons say people who get it after having a baby often notice it within 4 to 6 weeks, but in 63 Israeli women the baby was 5.4 months old on average, and some cases start in pregnancy (never before the fifth month in one small series).
Who gets it isn't settled either. In the Israeli group, a pregnancy over 40 weeks, a first birth and a body mass index over 25 were linked with it, while twins and a birth weight over 3.5 kg weren't (the baby's weight when it started wasn't recorded). Carers who aren't the birth mother get it too, and in one study of people caring for babies, how often they lifted mattered. Whether hormones or lifting is the cause isn't known, the British Society for Surgery of the Hand (BSSH) says.
Carpal tunnel syndrome that starts after the birth is different. In two small series it began a few weeks after the birth (3.5 weeks on average in one), mostly in women who were breastfeeding, without swelling, and lasted about 6 months, starting to ease within 14 days of weaning; all 27 women in one series were free of symptoms by a year, 2 of them after an operation.
Sources 31, 25, 32, 33, 34, 35, 36, 37, 38, 39, 40
Rarer causes, each with its own cluesEmerging evidence
Rheumatoid arthritis often eases in pregnancy (an estimated three in five women improve), but almost half of women who have it have a flare after giving birth, Arthritis UK says. Several swollen, warm, stiff joints, often in both hands and stiff in the morning, need a GP, because diagnosing it quickly matters. Problems felt in the hand can come from a trapped nerve in the neck, even without neck pain, though this is rare in pregnancy. Postpartum neuralgic amyotrophy, an inflammation of the nerves to the arm, is rare too: in a series of 11 women, strong shoulder and arm pain started from 1 to 2 hours to 2 weeks after the birth, weakness followed, and 8 of the 10 who were followed up got back 90% to 100% of their function.
Falls happen in 25% to 27% of pregnancies, a review found, and a fall onto the hand can sprain or break the wrist. Thinning of the bones linked with pregnancy and breastfeeding is rare and mostly causes fractures in the spine. The causes that aren't the hand at all have their own signs: sudden swelling with a headache or vision problems (pre-eclampsia), one arm suddenly weak with a drooping face (a stroke), numbness in both arms with dizziness, double vision or changes in speech, and a hot, swollen joint with a fever. Each is uncommon, and the NHS asks you to get help for any symptom you're worried about.
Sources 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 27
When a scan or test helpsStrong evidence
Usually none in pregnancy. "Tests are not usually needed as symptoms in pregnancy and postnatally normally resolve in the first few weeks to a few months after baby is born", an NHS trust leaflet says, and nerve conduction studies "are not essential to make a diagnosis", NHS inform says. A UK hand surgery pathway from Getting It Right First Time (GIRFT) and BSSH keeps nerve tests for when the diagnosis is uncertain, another nerve may be involved, symptoms come back, or diabetes or another nerve condition is present. In one Iranian study, examination tests agreed poorly with nerve tests, which is one reason the story and the pattern matter most.
Tests answer specific questions. After a fall onto the hand, an X-ray checks for a break: UK radiation guidance asks about pregnancy for X-rays between the diaphragm and the knees, so a wrist X-ray is outside that area, but tell the staff you're pregnant or breastfeeding, as the NHS asks. Blood pressure and urine checks look for pre-eclampsia. Nerve tests help if symptoms are severe, don't settle after the birth or an operation is being considered, and scans aren't usually needed for De Quervain's.
Sources 53, 16, 54, 55, 6, 47, 56, 57, 28, 31
How it usually goes, in pregnancy and after the birthMixed evidence
In pregnancy, carpal tunnel symptoms usually build towards the third trimester and are worse at night. A night splint and the everyday changes help most women: in Malmö, splints at night made 46 of 56 women symptom-free, and few women need an injection or an operation.
After the birth most women improve, but how quickly depends on who was studied. In 48 American women seen a month after the birth, symptoms had gone completely in 76%; in 46 Turkish women, 10.9% still had symptoms at 6 months and 4.3% at 12 months; and in one retrospective series, all 40 women whose symptoms started in pregnancy were better within 2 weeks of the birth. At the other end of the range, about half still had symptoms a year later in small, selected Italian clinic groups (54% of 63 women in one), and a review of those groups reported about 30% at 3 years; these figures come from the studies' published summaries (abstracts), and the groups were selected, so they may not apply to most women. Even there, pregnant women were 3 to 4 times likelier to improve than other women with carpal tunnel syndrome, and 85% needed no further treatment 3 years on.
UK leaflets say symptoms normally settle within the first few weeks to a few months after the birth, sometimes longer while breastfeeding. Breastfeeding-related carpal tunnel syndrome lasted about 6 months and eased after weaning. De Quervain's after the birth often settles too: milder cases recover over a few weeks, BSSH says, and most resolve without treatment but can take several months (NHS Lothian); in the Israeli group, symptoms lasted 5.15 months on average, and in one small trial, 8 of 9 women treated with a splint got better at the end of breastfeeding. No study has looked at whether carpal tunnel syndrome comes back in a later pregnancy, and no one can promise a timescale.
Sources 1, 2, 4, 3, 58, 24, 40, 59, 9, 60, 61, 53, 62, 18, 39, 38, 63, 34, 64
