IBCLC Study Notes | Repetitive Stress Disorders | Carpal Tunnel Syndrome

May 1, 2019 Shondra Mattos

Carpal tunnel is a painful disorder of the hand/wrist often resulting in numbness, tingling, and weakness (paresthesia) caused by the compression of the median nerve. The compression may be due to swelling of the wrist or due to the tendons that run alongside the carpal tunnel.

Carpal Tunnel Syndrome can arise in pregnancy due to the effects of relaxin on the tendons. May take weeks or months to resolve. Breastfeeding has shown to extend the time of CTS symptoms.

Symptoms: weakness, tingling, pain with the opposition of the thumb, burning, aching that radiates to the forearm and shoulder joint.

Pain may be intermittent or constant and is often most intense at night.

Carpal tunnel syndrome can impact a parents ability to hand express and may make using a hand pump difficult.

The weakness caused by Carpal Tunnel Syndrome may result in a lacking of strength to hold/help the baby's head.

A wrist brace can help provide stability to the wrist and reduce discomfort.

Biological laid back nursing would be the preferred first solution option if the baby is physically capable enough to do so (full term & healthy). Side lying is another option that may work better for premature babies or babies with health issues that make the prone position unsafe.

Note that side laying positions may trigger the nerves in the wrist if the affected wrist is on the arm that's being laid on.

Identify other hands-free positions that the parent and baby might be able to try safely and comfortably. Avoid positions that require a bent wrist position.

Utilize tools that a parent may have on hand that may make breastfeeding more comfortable: bed pillows, rolled/folded baby blankets (particularly under the wrists), specialized feeding pillows, etc. Moldable or "feathery" type pillows may be preferred. The goal is to let the pillows support the weight of the baby and the parent's hand to gently support the baby's head while the pillows actually support that hand, too.

A baby sling or other manageable baby wearing device may help provide support while breastfeeding.

Acupuncture, turmeric, or corticosteroid injections may help to reduce pain. Cold compression and Ibuprofen can be used to reduce pain and inflammation. Diuretics may help reduce swelling as well. Many parents report wearing a splint at night and keeping the hand elevated provides relief in their symptoms. Longer splints are often preferred over shorter ones, which could put additional pressures on the wrist.

If partners are present and carpal tunnel is severe, the breastfeeding parent's partner may hold the baby in position to breastfeed.

Advise the client that stretches may be helpful and if not already not seeing one, recommend/refer to PT or OT.

Eliminating Inflammatory foods may help reduce the inflammation of the wrist. Complex B6 supplements may also be helpful.

If breast support is needed, it may be possible for support to be provided by pulling up the breast from the top (with straight wrist). Pressure can be applied using the forearm when compression is necessary. Using a small massage device (like the rollerball kind) and vibration on the breast to massage may be helpful as well.

Thyroid conditions, rheumatoid arthritis, and diabetes can be associated with Carpal Tunnel Syndrome.