Hand and Wrist Pain During Pregnancy: Causes and Relief Strategies
⌚️ read time: 6 minutes
It certainly would not be earth-shattering of me to say that pregnancy brings a host of unexpected challenges.
Perhaps more surprisingly is how commonly we see hand and wrist conditions as a result of pregnancy. Many expectant mothers experience conditions such as carpal tunnel syndrome (read about it here), De Quervain’s tenosynovitis (read about it here), and generalized painful hand swelling, either during pregnancy or in the postpartum period.
In this article, I’ll explore the causes of perinatal hand and wrist pain and offer strategies to manage the symptoms as best as possible.
Also. I’ve never been pregnant, nor will I ever understand what it’s like. Feel free to call me out if I accidentally sound too preach-y. I’m really just trying to convey what we know about the hands and wrists, and how I treat them in my clinic.
Why do my hands and wrists hurt during pregnancy?
I bet you didn’t know that hand surgeons and OB/Gyn docs had a special relationship. But it’s true, we get a lot of patients referred from OB clinics.
Several factors contribute to hand and wrist pain during pregnancy, and no surprise, they are often linked to the physical and hormonal changes that occur in the body.
Fluid Retention
This is a big one. Hormonal changes during pregnancy often lead to fluid retention, which can cause swelling anywhere (or everywhere) in the body. If this includes the hands and wrists, you may be facing a painful encounter with carpal tunnel syndrome.
Remember that carpal tunnel syndrome occurs when the median nerve is pinched while traveling through the carpal tunnel (review the article here). It travels through that tunnel alongside nine flexor tendons that function to bend your fingers. If all nine of those buggers swell with fluid due to hormonal changes? That poor median nerve doesn’t stand a chance. It will be squished up against the carpal tunnel ceiling and you get carpal tunnel syndrome.
Side note: Even if it doesn’t result in full-blown carpal tunnel syndrome, we also commonly see generalized hand and wrist swelling. This fluid build up is particularly bad in the mornings while pregnant. Classically you may think of this occurring in the feet and ankles, but we often see it in the hands as well.
Posture Changes
As fun as it is to see that baby bump grow, saying that it takes a toll on mom’s body would be the understatement of the year.
In addition to plenty of discomfort, the growing belly will slowly change mom’s center of gravity and may lead to changes in posture. This altered posture can change the way in which we use our hands and wrists for repetitive daily tasks.
Even small changes in repetitive motions can take a big toll on the hands and wrists (see below).
Repetitive Motions
Not only is pregnancy a time of tremendous body changes but also of tremendous life changes. Particularly with a firstborn, there is a LOT to do to get ready for the baby. Call it nesting or whatever you please, but there’s no shortage of preparation in the lead-up to delivery day.
So take that extra workload, mix it with everything mom is doing already (working a full-time job, taking care of other kids, or perhaps even both!), and sprinkle in the hormonal and posture changes above…you’ve got a tailor-made recipe for tendinitis.
While this can creep up in many forms, the classic one is De Quervain’s tenosynovitis. As a brief review, this is a very painful condition of the thumb side of the wrist, often causing lightning-bolt sharp pains with even the most basic of wrist movements.
We commonly see this condition during pregnancy, but even MORE so postpartum with all the head cradling, baby-lifting, and wrist-intensive activities of being a new parent.
What to Do About Hand and Wrist Pain During Pregnancy
So as with any condition, it can be helpful to understand strategies you can safely employ at home versus those worth seeing a doctor for. Let’s break it down by condition.
Carpal tunnel syndrome
If you are developing pregnancy-induced carpal tunnel syndrome, look out for burning or electrical pains in the thumb, index, middle, and ring fingers. This is often associated with numbness or a tingling sensation in these same fingers.
Typically, these painful symptoms are worse at night.
While you can always try things like gentle movement, ice, or basic stretches, the real meat of your improvement lies in 3 strategies. Wrist brace. Injection. Or Surgery.
And I wouldn’t recommend the last option if you can at all avoid it while pregnant.
Here’s the interesting thing about pregnancy-induced carpal tunnel syndrome. As soon as you deliver the baby? These symptoms melt away almost instantly.
So we really just need to get you to delivery day. That’s the goal.
The least invasive strategy is nighttime bracing. Just like in all other forms of carpal tunnel, the symptoms are worse at night and they get more severe the more our wrist is bent (a common phenomenon while we’re in deep sleep).
So pick up a basic wrist brace from your local pharmacy that holds your wrist straight. And sleep in it every night. Hopefully, after a week or two you will start to notice an improvement in your symptoms as the nerve recovers.
If this isn’t working? Sometimes carpal tunnel symptoms are simply miserable and need a bigger intervention. And short of surgery, that intervention is a steroid injection into the carpal tunnel.
While this doesn’t fix the carpal tunnel syndrome, it can make you feel better for a while. It’s difficult to predict how long you might get relief, but the hope is for a couple of months as you near delivery.
In theory, steroid injections like this during pregnancy are safe. There are some minor theoretical safety concerns that have never really panned out in the real human body. But this is always worth discussing first with your OB/Gyn doctor.
(Spoiler alert: OB docs send me patients for injections ALL the time, so clearly many of them feel the tradeoff is worth it).
De Quervain’s Tenosynovitis
Even simpler than carpal tunnel syndrome? Bracing and injections are your options here.
As much as I wish it were different, therapy, exercises, or stretching just have never been shown to work for this painful tendinitis.
So if you find yourself getting sharp wrist pain near the base of your thumb and sometimes traveling up the forearm, the first thing I want you to do is get a wrist brace with a thumb extension.
This is often called a thumb spica brace.
Please start sleeping in this immediately. If you’re really hurting, I also recommend daytime use as close to 24/7 as possible for the first 3 weeks (it is not lost on me how paternalistic this sounds — easy for me to say right? But 24/7 brace wear while pregnant or with a newborn is NOT easy). My full bracing framework can be found here.
The goal is to do your best. This tendon unit needs rest to be able to heal.
And if the brace wear just isn’t cutting it? A steroid injection is VERY effective as a companion to the brace to get this to feel better faster.
Side note: This condition is more common after delivery. We even see it in the non-pregnant partner as well. A lot of lifting a baby out of a crib can give you this tendinitis. As can the position of nursing a newborn. Basically anything that applies stress to the wrist while it is in flexion or ulnar deviation (see below the tilted-to-the-ground position we often use to hold a phone or scissors). This is the position to avoid when you’re making necessary modifications to the above activities.
She is holding her phone in classic 'ulnar deviation' position
Generalized Hand and Wrist Swelling
I’ve got to tell you. I’m not aware of much that’s effective in making this generalized swelling go away during pregnancy. Ask your OB, but my understanding is this is a miserable side effect of those intense hormones.
That being said, I do know a thing or two about swelling in the hand/fingers.
Movement. And Elevation.
This is your guiding mantra.
Seriously, the more you keep swollen fingers moving, the happier they’ll be. Fingers HATE being stiff — and swelling causes stiffness.
Gently move them as straight as you can and into a fist as much as you can. This will squeeze that fluid out and keep them from getting stiff and painful.
And though elevation is easy to say, I find my patients largely roll their eyes. Ok ok doc, I’ll elevate, blah blah.
But this is underrated magic! Keep that hand above your elbow as much as you can!! Bonus points to get it over your heart (but this is less practical).
Gravity is your very best friend here. This is hands down (pun intended) the most effective technique to help with swelling. Hand. Above. Elbow. As much as you possibly can. Keep those fingers moving as well and you have a double-whammy strategy to feel better as soon as possible.
What I Would Do
I don’t know if this is considered a pro tip, or what, but here’s what I would do if I were having any of the above symptoms.
If the symptoms last for more than a couple days, or are clearly worsening, contact your OB for a referral to a trusted hand surgeon. Sometimes this process takes more time than we’d like, so get the process started. Having an appointment on the calendar is huge.
Then, use the above-mentioned home remedies. Use the braces, the stretches, the activity modifications. This helps you in two massive ways.
Most obviously, if your symptoms go away with at-home treatment, awesome! You can just cancel the specialist appointment.
But if your symptoms persist? Now you show up at your appointment with the hand surgeon super well-informed AND you’ve already tried the basics. This will make your appointment ridiculously high-yield. I promise you will get so much more out of that visit.
Who has time to be running all over town from specialist to specialist for every little thing that pops up? Especially while pregnant.
This is a high-leverage strategy.
Final Note
I’m not going to sit here and say things like ‘maintain a better posture’ or ‘limit repetitive activities.’
You already know that, and you still have to live your life.
Sure, if there are things that really hurt and you can find a way to modify around them or ask for help, please do that! Minimize where you can.
But making you feel guilty for continuing to do the things you need to do to care for your family is just ridiculous. At the end of the day, you still need to nurse your newborn, lift them out of the crib, etc.
So yes, modify as best as you can. And I find that just knowing what the underlying cause is often helps. The above tools and strategies will hopefully be the extra little trick you need to kick these miserable conditions.
And if you're reading this because you have a new little one or one about to join, congratulations! I'm sending my best to you and your growing family.
Takeaways:
Hand and wrist pain during pregnancy is common, but it doesn’t have to be debilitating
By understanding the causes and implementing effective treatment strategies, you can help minimize discomfort
Oftentimes these conditions need professional treatment. Give the at-home strategies a try, but know that some of these may just need an injection to get you through
Hopefully this helps. Obviously, each of these could do with its own really deep dive (for instance, how exactly should we think about modifying child-caring activities to avoid De Quervain’s).
But the goal today was to get an overview under our belts.
As always, let me know what resonates and if there’s more you’d like me to explore in upcoming posts!
