Management of Carpal Tunnel Syndrome in Pregnancy

Clinical Presentation and Diagnosis

Carpal tunnel syndrome in pregnancy is commonly exacerbated, with classic symptoms including nocturnal numbness and tingling in the median nerve distribution, and a positive Phalen's test, according to the American Academy of Neurology 1, 2

The American College of Obstetricians and Gynecologists recommends conservative treatment, including nighttime wrist splinting, as the initial management step for carpal tunnel syndrome in pregnancy, with a strength of evidence rated as moderate 3
The American Academy of Orthopaedic Surgeons suggests that injections should not be first-line in a pregnant patient when conservative splinting has not yet been attempted, due to theoretical risks during pregnancy 3
The American Academy of Neurology states that NSAIDs and acetaminophen have not shown benefit for carpal tunnel syndrome and do not address the underlying median nerve compression, with a strength of evidence rated as low 3

The American College of Surgeons recommends that surgery is absolutely contraindicated as initial management in pregnancy, given the high rate of spontaneous postpartum resolution, with a strength of evidence rated as high 3