Carpal tunnel surgery with infant at home

April 28, 2016 11:12 PM

Two pronged question: Has anyone had carpal tunnel surgery with an infant to look after? Also, please read my litany of things I've tried and tell me if there's an obvious treatment I'm missing.

My left hand thumb, index, and middle finger have been numb for about 2 months. Sometimes it extends into my palm but never past my wrist. I started occupational therapy a month+ ago where we've done tissue work, tendon glides, kinisio tape, and I've been wearing a splint intermittently. I've also had my chiropractor work on this during my visits (I've seen her 3 times since the problem started). I also see an acupuncturist who, in addition to needle work, does kinisio tape, soft tissue work, and cupping). I see her every other week. I've also had a massage focused on this issue. They've all recommended posture changes which I've tried to work in.

YANMD but are there things (obviously I'm okay with less conventional treatment) that I haven't tried which you've had success with?

I had a EMG done today which showed moderate carpal tunnel syndrome. The doctor who conducted the test said that a cortisone shot wouldn't bring lasting relief in my case (don't recall why), that the issue was isolated to the carpal tunnel (and not related to something wrong further up my arm or in my neck), and that she'd like me to see an orthopedic surgeon for a consult.

Layer on top of this that I'm looking for work (was laid off and have been a full time mom), have an almost 6 month old baby who just started the clingy phase, and feel a bit overwhelmed by the idea of surgery.

In addition to the what else should I be doing, I need to know what to ask the surgeon and what help to ask for post op.

posted by toomanycurls to Health & Fitness (13 answers total)

I haven't had the surgery, but I'm about in your shoes, just three months along. When my baby was about six months old I was found to have moderate carpal tunnel and told that I was a candidate for surgery. But my doc also mentioned that pregnancy can often exacerbate carpal tunnel, and lifting my extremely wiggly baby all the time was probably exacerbating it too.

Long story short, I keep postponing actually scheduling the surgery because my life has just been way overscheduled and I haven't found the time. But I've also found that it seems to have gotten a lot better, without me doing much other than trying to moderate my levels of typing, and asking for more help with baby lifting / opening lids and so forth where possible. Where three months ago I was getting pins and needles all of the time, it's diminished to the point that now it just happens after a bunch of typing or baby-lifting.

tl;dr, I'm not saying you will be the same, but it may be that some of it will improve over time, as you gain more distance from pregnancy. At this point if I magically had a couple of weeks free to do and recover from the surgery, I'd probably still do it, but as it is I probably won't; it's not bad enough to justify the cost and the enormous hassle that recovery with a small infant will impose.

That said I'm not a doctor and I assume a doctor would frown upon this course of action.
posted by forza at 11:19 PM on April 28, 2016

Have you been prescribed any of the high dose NSAIDs? Have you tried night splinting?
posted by xyzzy at 11:46 PM on April 28, 2016 [2 favorites]

I'm a midwife and I agree that pregnancy can often exacerbate carpal tunnel--mostly having to do with fluid shifts, weight changes, and the effects of hormones on joint laxity. Add on infant care and the generally stressful nature of the post-partum state/sleep changes/etc., and it's not surprising that you're having pain. I have had patients have good results with bracing and lifestyle modifications (ergonomics, etc.) during pregnancy, but I refer all of my patients for OT/PT/ortho, and don't do a lot of follow-up in that department.

I think the surgery is generally pretty straightforward (and even done under local) but if you're already feeling overwhelmed with the option, as well as baby care, can you ask your doc about doing corticosteroid injections for short- or medium-term relief?
posted by stillmoving at 1:24 AM on April 29, 2016

I'm a licensed massage therapist, and I can *always* help with this condition if people will come in for a series of sessions (6 is a good starting point, preferably 2 short sessions the first week), and follow the lifestyle changes I recommend. I find it upsetting when a new patient comes in with scars and possibly dysfunction from a carpal tunnel surgery having never tried less invasive alternatives.

Do not go to a crappy chain like Massage Envy. Go to a good, licensed, medically-oriented individual therapist. It makes a difference. A massage is not a massage is not a massage.

You should make sure that the splinting you're doing includes always wearing it overnight. Otherwise, you can end up in a position where you're flexing or extending your wrist for a prolonged period of time without realizing it. Nothing you do the rest of your day can overcome 8 hours of pinching on your median nerve.

You may try NSAIDs, as a previous poster mentioned, but realize they do have significant side effects. IMO better to try natural versions of anti-inflammatories, such as spices (turmeric, ginger) or icing the wrist periodically. I also highly recommend an anti-inflammatory pain gel called Pain Wizard, available online only (I'm not affiliated with them).
posted by mysterious_stranger at 4:26 AM on April 29, 2016 [1 favorite]

You've done occupational therapy, but did you do physical therapy? That was what helped me with posture changes, which turned out to be the primary cause of all my problems. Not just "try to sit up straight" but "here are exercises to relax your pectorals, strengthen rhomboids, and stretch the trapezius." I started with isometric exercises and then went up to the theraband rubber band thing and after that, actual weights. That process took ~ 6 months but it was worth it.

I don't think you can improve your posture through mindfulness alone, I think you have to actually strengthen the correct muscles that align your spine/shoulder--tight muscles are not necessarily strong. I found this helped tremendously: as the song says, the wrist bone is connected to the arm bone is connected to the neck bone, etc etc. I still have passing occasional numbness or tingling if I've been overdoing it or slept funny, but the pain and paresthesia is 90% gone.
posted by epanalepsis at 6:45 AM on April 29, 2016

This book, Conquering Carpel Tunnel, which was recommended here on AskMe, really, really helped me. Don't be put off by the illustrations - the stretches in it WORK.

I had carpel tunnel from a bad set up at work, and was able to fix it with a combination of methods: massage and acupuncture, braces - both at work and at night, the night ones being more important, making sure my work set up was ergonomic, and that book which I think helped more than anything other than changing the set up at work. I was fine for awhile and it flared up again when I got pregnant.

During pregnancy and after the baby was born it was hard to manage - I found nursing and baby-holding really triggered it. Something about the way you crook your hand to hold a baby's head is really triggering. These days I manage it by using all completely ergonomic tools at work, regular massage, and stretching. Make sure you go to a massage therapist who does more of a medical model, as said above - not a spa-type. They may need to work on your shoulders as well.

I've not had to have surgery or even take NSAIDs so this can be managed with time and effort (in your tons of free time, right??), as well as some willingness to have a little bit of pain while you're waiting for all this work to take effect.
posted by john_snow at 6:50 AM on April 29, 2016

2nd mysterious_stranger - I have chronic RSI-related *tendon* pain (no numbness) in my wrist and forearm, and two things have helped: 1) deep massage and electroacupuncture. Worked for almost a year, until I woke it up again by carrying slightly overly heavy groceries for a little too long (damn canned beans). And later, 2) 24/7 bracing in a hard splint for 4 weeks, with ergonomic changes all around. I.e. serious rest. (I know I've seen comments on Ask by new moms who've had RSI and carpal tunnel issues, specifically, talking about how they did mom things, it's worth a search.) I would get any gadget/s that let you rest that hand as much as possible (a sling? Sorry, not a mom). PT exercises did not work for me, only rest (and massage, that time).
posted by cotton dress sock at 7:01 AM on April 29, 2016

Pregnancy can totally exacerbate carpal tunnel - mine went away on its own about 3.5months after the birth (just about the time I had started feeling like surgery was in the cards for me!). I know yours didn't start up until after the baby was already born, but you might want to wait a little longer to see if it resolves on its own.
posted by Ausamor at 8:30 AM on April 29, 2016

I second the book recommended by john_snow (although I may have been the original recommender too!)

Can't imagine dealing with the post-surgery with a baby. I was told to not use the hand for ANYTHING for 4 weeks.
posted by callmejay at 9:12 AM on April 29, 2016

I'm thirding wearing a splint all night. This totally works for me.

Also I realized that besides computer work the number one cause for me was gripping the steering wheel too tight and also gripping the steering wheel with my wrists at a weird angle. So I try to relax while driving and keep my wrists/hands straight while driving. Do you drive a lot? Is driving more stressful for you now because you have precious cargo?

I take fish oil to keep inflammation down. I would die without fish oil. But I am not a doctor so ask your doctor if it is OK for you to take.
posted by cda at 9:38 AM on April 29, 2016

I also had pregnancy/postpartum-related carpal tunnel syndrome. It lasted for several months after giving birth. I saw my doctor and a physical therapist, I wore splints and compression gloves, all of which helped a little. Ultimately, though, I just needed time to let things settle down. In the US, we pretend that the postpartum period is a few weeks maximum, but that is just not the case! I was still having other weird postpartum stuff 10-12 months after my son was born. He's now 20 months old, and I have no issues with carpal tunnel syndrome now, despite a typing-heavy full-time job.

I would really caution you to give it a little time, if you can. Not only will a few more months make a difference with postpartum symptoms, but it may be that the way you are sleeping now or the way you are holding/nursing your infant is exacerbating things. (For instance, mine was definitely worsened by the side-lying nursing position (which I loved) and co-sleeping scrunched on my side.) And if that's the case, it may very well change in the next few months as your little one grows and gets more independent. I felt that my guy got more independent at the 6mo mark: I was holding him less as he got mobile, he was sleeping longer on his own, etc. Waiting out these natural changes could help you avoid surgery.

Obviously I am not a doctor and you should follow doctors' advice. And you should be comfortable (and I know the numbness sucks, oh how I know!) I assume you've worked with your doctors and specialists to connect dots in terms of how you hold & nurse your infant, and how you lie when you sleep, and whether there are changes you can make there. And I'm sure you would not go in for surgery without exhausting all options, including second opinions.

Still, I suggest you stall on surgery, if you can, as even a few months may make a difference. Postpartum is a really crazy time!
posted by aabbbiee at 9:45 AM on April 29, 2016 [2 favorites]

My ex did a lot of weight lifting (in order to be able to do his job) and when he took a break from it, he developed tendon issues from being at the computer. He saw a doctor who told him that weight lifting can help with this. He returned to lifting weights and his symptoms resolved.

At age 19, I injured the tendons and ligaments in my dominant arm taking a tennis class. In my twenties, this became quite debilitating. I learned to brush teeth, use the mouse, etc with my non dominant hand to give my dominant hand a break. I also consumed gelatin as a supplement daily for a year or two, to feed the tendons. I still have some limitations and the occasional flare up, but it isn't debilitating anymore.

So, you could try weight lifting. You could try feeding the tendons with supplements. You could try doing more with your unaffected hand to give your bad hand a break.
posted by Michele in California at 10:44 AM on April 29, 2016

I had a similar issue, and my orthopedic surgeon discouraged me from having surgery and told me the pain would go away once I stopped nursing. He said it wasn't a pregnancy thing, but related to the hormones released while nursing. So this meant I was in excruciating pain until my daughter was almost two, but as soon as she stopped, the pain went away very, very quickly. My doctor told me that the complications from surgery could have made this problem last the rest of my life, but just waiting would likely solve it completely. I've lost some of the strength in my wrist but have no pain, so his advice was good.

As for getting through that time, I was fitted with a plastic brace, and I found that warming it before wearing it, and warming my arm directly, helped tremendously. I'd sleep with a small heating pad next to my bed and if the pain woke me, I'd just wrap my arm and warm it. I needed to warm it for ~20 minutes every morning just to be able to get out of bed the pain was so bad, but it was worth it to me to keep nursing. I used those OTC heating wraps too, the chemical kind for sports injuries. I kept a few in my car/purse so that if I was out when the pain struck I could pull one on.

Additionally, periodic steroid injections really, really helped. They aren't recommended more than a small number of times because they can cause major tendon damage after just a few injections, but when the pain was at its absolute worst, they were the best.
posted by Capri at 5:28 PM on April 29, 2016