Steroid injections can provide pain relief for mom without affecting baby

Jun 13 2014

From weird cravings to swollen feet, pregnant women deal with a lot during those nine months Some women even suffer from hand pain when there are simple, baby-safe options to treat the symptoms.

Carpal tunnel syndrome and de Quervain's tenosynovitis are the two most common causes of hand pain for women who are expecting or have just delivered.

"Most women think pain caused by swelling in the hands is just another joy of pregnancy that they have to deal with," said Shari Liberman, M.D., a Houston Methodist orthopedic surgeon and hand and upper extremity specialist. "In fact, there are several baby-safe options that can provide pain relief for mom."

Carpal tunnel syndrome is common in pregnant women due to the increased fluid retention in their hands. The carpal tunnel houses several tendons and the median nerve, which provides senses for the thumb, the first and middle fingers, and half of the ring finger and motor movement for the thumb.

"The carpal tunnel does not function as a balloon, so it cannot expand when a tendon becomes inflamed or if increased level of fluid is in the tunnel," explained Liberman. "In expectant moms, the increased fluid in their hands puts pressure on the median nerve, which can cause numbness or tingling in the fingers controlled by that nerve."

While most causes of carpal tunnel syndrome are not reversible, a pregnant woman will see decreased fluid retention and resolution of symptoms once she gives birth. While waiting for their due date, Liberman advises her pregnant patients to splint the wrist and to get a steroid injection.

"When I recommend a steroid injection, many think that will hurt the baby, but it won't," Liberman said. "Whether the baby is in utero or breastfeeding, there are steroid injections that can provide pain relief for mom without affecting the baby."

De Quervain's tenosynovitis is common in new mothers because of the awkward hand positions used to care for or breastfeed a baby. It occurs when one or both of the tendons that move the thumb become inflamed. The compartment which houses the tendons is just the right size for the tendons, much like driving a car through a tunnel. When a tendon becomes inflamed, Liberman likens it driving a truck through the tunnel.

"De Quervain's can be a vicious cycle," said Liberman. "Because the inflamed tendon keeps hitting the walls of its compartment, it stays irritated and inflamed."

Liberman recommends a steroid injection to provide immediate relief and splinting to give them the inflamed tendon time to heal. This will resolve the symptoms for 90 percent of patients. Symptoms of de Quervain's include pain in the thumb-side of the wrist which can radiate down the thumb or up the forearm and an increase in pain when moving the hand or thumb.

"During my pregnancy, I dealt with de Quervain's, so I know how painful it can be," said Liberman. "For me, splinting was enough to resolve the symptoms. If you are a new mom dealing with thumb pain, I encourage you to ask your ob-gyn or orthopedist about baby-safe options that can help relieve your pain."