carpal tunnel syndrome in lactation: a challenging issue

Carpal tunnel syndrome (cts) is a prevalent complaint during pregnancy and lactation. during lactation both environment and hormonal changes can contribute to worsening the symptoms. some authors believe that cts in lactation is a separate clinical entity which develops in pregnancy. therefore, the specific conditions of these patients demand a special assessment of their treatment. we searched pubmed, scopus and google scholar regardless of the articles' publication date. the search was performed using the terms “carpal tunnel syndrome” “median nerve entrapment” or “median nerve neuropathy” which were independently associated (by using "and" in the builder) with breastfeeding, lactation, nursing, postnatal, postpartum, puerperal, and puerperium. we restricted our search to the articles published in english or persian. the abstracts of references were carefully reviewed and included, if related to cts and lactation. finally, the extracted data about therapeutic options available for mothers during breastfeeding were assigned to different areas such as surgical, medical, etc. related articles were then discussed under the most appropriate topics. usually, gradual resolution of the symptoms of cts occurs after stopping breastfeeding. reassurance and nursing advice on optimal positions for holding baby and breasts during breastfeeding is the first step of treatment. intra-carpal steroid injection, diuretics and non-steroidal anti-inflammatory drugs might have some benefits, according to the few observational studies on lactating women with cts. splinting as a safe option that does not interfere with breastfeeding with good efficacy is suggested by all authors. surgical intervention is spared for the patients experiencing severe symptoms for long periods, those with thenar muscles wasting or when conservative treatment fails. current evidence suggests that in addition to nursing advice regarding positioning during breastfeeding, similar treatment strategy for cts in general population is suitable for lactating mothers. however, available studies suffer from many shortcomings and have not evaluated all therapeutic options in this field. well-designed interventional studies with special focus on this issue are needed to provide evidence based recommendations