Hand and Wrist Conditions in Pregnant and Postpartum Women (Orthotic Solutions)

As a Certified Hand Therapists, we see these conditions all too often. Patients report new onset of pain in their hands while pregnant or as new mothers, and this makes perfect sense. They've gone from casual daily tasks to becoming a 24/7 baby-care machine. Awkward bottle or breastfeeding positions, repetitive rocking motions, the dreaded middle-of-the-night diaper fumble, constant picking up and carrying of baby (and carriers, bags, etc.) — their poor hands are working overtime.

The excellent news? Custom orthotic fabrication provides highly effective, conservative treatment that can dramatically improve these patients' quality of life. Let's examine the three most common upper extremity conditions in this population and the specific orthotic interventions. 

Before diving into specific conditions, it's important to understand why custom orthotic fabrication is particularly effective for pregnant and postpartum patients:

• Ideal for patients who prefer to avoid medications during pregnancy and breastfeeding
• Properly fitted orthoses provide instant support and pain reduction
• Allows patients to continue essential childcare activities with reduced pain
• Effective conservative treatment that often prevents the need for invasive interventions
• Orthosis can be adjusted as symptoms change throughout pregnancy and recovery 

The increased prevalence of hand and wrist conditions during pregnancy and postpartum is multifactorial:

• Hormonal changes: Fluctuations in hormones, including relaxin secretion causes flattening of transverse carpal ligament
• Fluid retention: Pregnancy-related edema increases pressure on nerves and tendons
• Medical complications: Gestational diabetes and hypertension can exacerbate symptoms
• Biomechanical factors: Prolonged awkward joint postures and repetitive motions during childcare activities 

The Challenge

While CTS affects only 1-5% of the general population, it impacts a staggering 31-62% of pregnant women.

Clinical Presentation

• Paresthesia of the thumb, index, and/or middle finger
• Wrist pain, particularly at night
• Decreased two-point discrimination
• (+) Tinel's sign, (+) Phalen's test, and/or (+) Durkan's test
• Thenar muscle atrophy in severe cases

The Orthotic Solution

A custom volar wrist orthosis is the most effective conservative treatment for pregnancy-related CTS. The orthosis maintains the wrist in a neutral position, reducing pressure on the median nerve and providing immediate symptom relief. 

Fabrication Considerations

• Position wrist in 0-10 degrees of extension (neutral)
• Extend from proximal palmar crease to 2/3rd length of forearm
• Allow full finger and thumb mobility
• Consider removable design for hygiene during frequent hand washing
• Wearing Schedule: Night wear is essential; daytime wear during aggravating activities. 

The Challenge

The second most common hand/wrist condition during pregnancy and postpartum.

Clinical Presentation

• Pain over the radial styloid
• Palpable thickening over the first extensor retinaculum
• (+) Finkelstein's test
• Pain with lifting, twisting, or wringing motions

The Orthotic Solution

A long thumb opponens orthosis that immobilizes both the thumb and wrist is crucial for resting the inflamed tendons in the first dorsal compartment. 

Fabrication Considerations

• Exclude IP joint of the thumb
• Extend to 2/3rd length of forearm for optimal wrist support
• Position thumb in slight radial abduction and opposition
• Ensure comfortable thenar and first web space contouring
• Wearing Schedule: Continuous wear initially, with gradual weaning as symptoms improve 

The Challenge

Paresthesia in ring and small fingers due to ulnar nerve irritation at the level of the elbow as the nerve courses the elbow posteriorly. 

Clinical Presentation

Numbness and tingling in ring and small fingers

Symptoms worsen with prolonged elbow flexion

Often bilateral due to feeding positions 

The Orthotic Solution

A nighttime anti-elbow flexion orthosis prevents the prolonged elbow flexion that exacerbates ulnar nerve compression; avoiding provocative sleeping positions.  

Fabrication Considerations

• Position elbow at 45-60 degrees of flexion
• Use soft padding to prevent pressure points
• Secure with comfortable strapping system

• Lightweight design for sleep comfort 

   

Wearing Schedule

Nighttime wear; education about daytime positioning and activity modification. 

Pregnancy and postpartum can bring unique challenges, and for many, this period is not without discomfort or difficulty. Custom orthotic fabrication offers an evidence-based, non-invasive approach that helps support comfort and function during this important time. Investing in quality orthotic care can ease symptoms, reduce the risk of chronic conditions, and promote long-term hand health, allowing patients to focus more fully on their well-being and their families.

Sources

1. Afshar A, Tabrizi A. Pregnancy-related hand and wrist problems. Archive Bone Joint Surg. 2021;9(3):345-349.
2. Cavus FM, Maden C, Turhan B. Comparison of the Effects of Volar-Assisted and Elastic Wrist Splints on Edema, Pain, Grip Strength, and Functionality in Pregnant Women With Carpal Tunnel Syndrome. Hand (N Y). 2024;19(4):648-655.
3. Daglan E, Morgan S, Yechezkel M, Frenkel Rutenberg T, Shemesh S, Iordache SD, Kadar A. Risk Factors Associated With de Quervain Tenosynovitis in Postpartum Women. Hand (N Y). 2024 Jun;19(4):643-647.  
4. Milano ME, Pennington MV, Ilyas AM. Diagnosis and Management of Carpal Tunnel Syndrome During Pregnancy. Obstetrics & Gynecology. 2025;145(4):439-448.