It is usually happening at two or three in the morning. Your thumb and first few fingers are tingling or completely asleep, you shake your hand until the feeling comes back, eventually fall asleep again, and then it happens the next night.

Sometimes both hands are doing it.

By the time someone mentions it to us, they have often already heard that carpal tunnel is common during pregnancy and will probably improve once the baby arrives.

And yes, that is often what happens.

But there is a fairly important piece missing from that answer: there are things you can do about it while you are still pregnant.

Pregnancy-related carpal tunnel is usually connected to the extra fluid and swelling that come with pregnancy putting pressure on a nerve at the wrist. It tends to become more noticeable later in pregnancy, it is very often worse at night, and simple changes such as keeping the wrist in a neutral position while you sleep can help.

So if your hands have suddenly joined the long list of body parts keeping you awake, here is what we want you to know.

The short answer: why do your hands go numb during pregnancy?

There is a small passageway at the front of your wrist called the carpal tunnel. Several tendons travel through it along with the median nerve, which provides sensation to your thumb, index finger, middle finger and part of your ring finger.

There is not a lot of extra room in there.

During pregnancy, your body naturally carries more fluid. When some of that fluid collects around the tissues at your wrist, pressure inside the carpal tunnel can increase and irritate or compress the median nerve.

That is what causes the classic numbness, tingling, burning, aching or weakness in the hand.

The little finger is usually left out of it, which is actually a useful clue. It is supplied by a different nerve.

What does pregnancy carpal tunnel feel like?

The location matters.

With carpal tunnel, numbness and tingling usually involve the:

• thumb
• index finger
• middle finger
• thumb side of the ring finger

Some people describe pins and needles. Others say their hand feels completely dead, especially when they first wake up. There may also be burning or aching through the wrist and forearm. For me, I felt like my hands were just stiff and sore, not even particularly numb. But they just didn’t feel right.

Then there are the things that do not immediately sound like a nerve concern.

Your grip may feel less reliable. You may find yourself dropping your phone or coffee mug more than usual. Buttons, earrings or zippers suddenly take more concentration. Your fingers can feel stiff or clumsy first thing in the morning.

Carpal tunnel can affect both hands, although it is very common for one to be much more annoying than the other.

Why does pregnancy cause carpal tunnel?

The biggest factor is swelling.

Fluid retention is a normal part of pregnancy. You may see it in your ankles or notice that your rings suddenly feel tighter. The same thing can happen around the tissues inside your wrist.

The difference is that your wrist has very little room to accommodate that swelling.

As pressure increases inside the carpal tunnel, the median nerve gets compressed. That is why pregnancy-related carpal tunnel often becomes more noticeable later in pregnancy, when fluid retention tends to be greater.

Daily positions can add to the irritation too. Think about how much time we spend with a wrist bent while typing, holding a phone, driving or sleeping with a hand tucked underneath a pillow.

That does not mean you caused your carpal tunnel by scrolling too much or sleeping the wrong way. Pregnancy has already changed what is happening around the nerve. Certain positions can simply make an irritated nerve more noticeable.

Why is carpal tunnel so much worse at night?

This is often the part people care about most because pregnancy has already made sleep complicated enough.

Most of us do not sleep with our wrists perfectly straight. We curl a hand under the pillow, tuck it beside our face or bend it without realizing it.

When the wrist stays bent, there is even less room around the median nerve. That is why carpal tunnel has such a habit of waking people up in the middle of the night, and why keeping the wrist in a more neutral position while you sleep can make such a difference.

If you are waking up, shaking your hand until the feeling returns and then doing the whole thing again a few hours later, that pattern is very typical.

What actually helps carpal tunnel during pregnancy?

If someone came into Oona tomorrow with classic pregnancy carpal tunnel, we would not start by giving them a giant list of things to do.

We would start with the basics.

Wear a neutral wrist splint at night

This is usually the first practical thing worth trying.

A wrist splint keeps your wrist relatively straight while you sleep so it cannot spend several hours folded into a position that puts more pressure on the median nerve.

The goal is not to squeeze or completely immobilize your wrist. It should feel supportive, not tight.

And yes, it is deeply unglamorous.

It can also be surprisingly helpful. My carpal tunnel started around week 13 of my pregnancy and I wore two wrist braces from the brand Bauerfeind throughout my entire pregnancy. We carry them in our clinics, and they’re covered by insurance.

Look at what your wrists are doing all day

This does not require turning your entire life upside down.

We are looking for the positions you spend a lot of time in.

Is your wrist bent while you type? Do you hold your phone in the same hand for long stretches? Are you sleeping with your hand folded underneath your head?

You do not have to spend the day policing every movement of your hands. We just want to reduce the long stretches in positions that consistently make the tingling or numbness worse.

Do not aggressively stretch an irritated nerve

You will find approximately six million carpal tunnel exercises online.

Some gentle wrist and nerve movements can be useful, but the right movement depends on what is actually causing your concern and how irritable the nerve is.

This is one of those situations where harder is definitely not better.

If an exercise makes the numbness or tingling noticeably stronger or leaves it hanging around afterwards, stop. That is a good reason to have someone assess what is going on instead of continuing to push through it.

Is it actually carpal tunnel, or something else?

This matters because not every sore wrist during pregnancy or postpartum is carpal tunnel.

One of the other wrist concerns we see all the time is de Quervain’s tenosynovitis, commonly called mommy thumb.

The two can feel similar because both involve the wrist, but they are not the same thing.

Carpal tunnel usually involves numbness, tingling or burning through the thumb, index and middle fingers. It is a nerve concern and is often particularly bothersome at night.

Mommy thumb usually causes pain along the thumb side of the wrist, especially when gripping, twisting, lifting or picking up a baby. It involves irritated tendons instead of compression of the median nerve. It’s more likely to happen after your baby is born than during pregnancy.

If your little finger is the one going numb, that is another clue that something else may be going on because the median nerve does not supply the little finger.

And if moving your neck seems to change what you feel in your hand, or the sensation travels from the neck or shoulder all the way down the arm, we want to look beyond the wrist too.

This is exactly why we assess before we treat.

When should you have numb hands during pregnancy checked?

Most pregnancy-related carpal tunnel is uncomfortable rather than dangerous.

But there are times when we do not want you simply waiting for the baby to arrive.

Have it assessed if:

• the numbness has become constant
• your hand or thumb feels noticeably weaker
• you are regularly dropping things because your grip is failing
• you notice muscle loss around the base of your thumb
• the concern is interfering significantly with normal daily activities

Those changes can mean the nerve is being compressed more significantly and deserve a proper look.

Does pregnancy carpal tunnel go away after birth?

Very often, yes.

As pregnancy-related fluid retention starts to settle after delivery, the pressure around the median nerve can decrease and many people notice their hands improving.

What we do not love is promising that it disappears the moment the baby is born, because that is not true for everyone.

There is also a very practical reason wrists sometimes continue to complain after birth.

Suddenly you are feeding for hours, lifting a baby dozens of times a day, carrying a car seat, supporting a little head and holding your wrist in positions it was not spending nearly as much time in before.

So if the pregnancy numbness does not settle, or it changes into a sharper pain around the thumb after your baby arrives, have another look.

The answer may still be carpal tunnel. It may now be mommy thumb. Sometimes there is more than one thing going on.

You do not need to figure that out yourself.

What does carpal tunnel care look like at Oona?

This is where being part of a multidisciplinary clinic is useful.

If you tell us your hand goes numb at night, we do not want to assume the wrist is the entire story before anyone has assessed you.

We want to know which fingers are numb, whether it happens in one hand or both, how your grip feels, what makes it better or worse, what your wrist is doing during the day and whether anything happening at your neck, shoulder or elbow could be contributing.

Then we decide what actually makes sense.

Sometimes the most useful advice really is to get the right night splint and change a couple of positions. Sometimes hands-on treatment and orthopedic physiotherapy make sense. Oona’s physiotherapists in Toronto and Newmarket treat carpal tunnel syndrome, wrist pain and repetitive strain concerns.

Depending on what we find, prenatal and postpartum chiropractic care may also be part of the conversation, particularly when the wrist concern is happening alongside neck, shoulder or other musculoskeletal concerns.

Acupuncture during pregnancy is another option available at Oona, including for pregnancy-related carpal tunnel concerns.

The important part is that we are not trying to send everyone to every practitioner. We are trying to figure out what is actually going on and where it makes the most sense to start.

Pregnancy carpal tunnel: questions we hear all the time

Is carpal tunnel common during pregnancy?

Yes. Pregnancy-related carpal tunnel is well recognized and becomes particularly common later in pregnancy as swelling and fluid retention increase.

Why are my hands numb when I sleep during pregnancy?

Pregnancy-related swelling can increase pressure on the median nerve inside your wrist. Keeping your wrist bent while you sleep can add to that pressure, which is one reason numbness and tingling are often much worse overnight.

Which fingers go numb with pregnancy carpal tunnel?

Usually the thumb, index finger, middle finger and part of the ring finger. The little finger is usually not affected.

Can pregnancy carpal tunnel affect both hands?

Yes. Both hands can be affected, although one may be noticeably worse than the other.

What is the best thing to do for carpal tunnel at night while pregnant?

A neutral wrist splint worn while you sleep is one of the simplest first steps. It helps prevent the wrist from staying bent for hours and can reduce pressure on the median nerve. We can order these in for you, and they’re usually covered by insurance.

Is pregnancy carpal tunnel the same as mommy thumb?

No. Carpal tunnel affects the median nerve and is known for numbness and tingling. Mommy thumb involves tendons along the thumb side of the wrist and usually hurts with lifting, gripping or twisting.

Will carpal tunnel go away after I have the baby?

For many people it improves as pregnancy-related swelling settles after birth. It can last longer for some people, so ongoing numbness, weakness or difficulty using your hand is worth reassessing.

Can carpal tunnel be a sign of preeclampsia?

Carpal tunnel itself is not preeclampsia. However, a sudden or significant increase in swelling, particularly alongside other pregnancy warning signs, should be assessed by your medical care team instead of attributed to carpal tunnel.

Can Oona help with carpal tunnel during pregnancy?

Yes. Oona’s orthopedic physiotherapy team treats carpal tunnel and wrist concerns, and other services such as chiropractic care and pregnancy acupuncture may be appropriate depending on what your assessment shows.

Do I need a referral to book at Oona?

You can book directly with Oona. Your individual extended health insurance plan may have its own requirements for reimbursement, so it is always worth checking your coverage.

If you do not know which practitioner to choose, start with the complimentary Care Navigator call instead of trying to guess.