de Quervain’s Syndrome in Motherhood…
What is it?
De Quervain’s Syndrome is known as a painful repetitive stress injury of one or two of the tendons on the thumb side of the wrist (shown in the diagram). These tendons straighten and move the thumb out from the hand. The tendons and/or the tight cover (sheath) over the tendons are thickened or swollen from ‘overuse’ or sometimes an acute injury.
What are the symptoms?
Pain and swelling can occur around the thumb, the thumb side of the wrist, and up the forearm. Thumb and wrist movement may be painful, especially when lifting and holding a baby. Pain also can occur when pinching, gripping, bending or moving the wrist sideways.
There can be reduced strength and movement of the thumb and wrist. It can be difficult to lift or use objects where thumb pressure is needed (e.g. lifting a plate, opening a door, and changing a nappy).
Occasionally the tendons can get stuck and the thumb can ‘pop’ or trigger due to the thickening of tissues.
What causes it?
De Quervain’s is usually caused by repetitive movements, especially extending and moving the thumb away from the hand and bending the wrist in the direction of the little finger (for example, when lfting a small child/baby under the armpits). It can also be caused by trauma to the thumb and/or wrist. The tendons involved become irritated and inflamed where they run through a tight tendon cover (sheath).
De Quervain’s is common in new mothers due to the regular lifting of their babies. Racquet sports, volleyball, golf, carpentry, video games, knitting, and mobile phone use are also risk factors.
How is de Quervain’s Syndrome treated?
The aim of treatment is to reduce pain and swelling and restore full thumb and wrist movement, strength and function. It is also important to develop new healthy habits regarding the way the hand and arm is used (e.g. lifting baby in a certain way) in order to prevent recurrence and further injury.
Initially, you will need to rest and protect the affected tendons by (ideally) wearing a custom splint or brace (from the forearm to the hand and thumb) for 3-6 weeks and take on new methods of safely lifting and holding your baby. Ice, massage, compression, taping, gentle stretches, and ultrasound may also benefit some people who have/make time for it. Gentle specific strengthening exercises are helpful after your symptoms have settled. No exercises should be painful. Everyone is different and it is therefore recommended you see a Hand Therapist (OT or Physiotherapist) to develop a program that will work for you. If there is no improvement after 6 weeks of conservative therapy, your therapist may refer back to your doctor for a possible steroid injection or surgical opinion.
General Advice and Precautions
· Avoid gripping or lifting objects in a way that bends your wrist sideways.
· Avoid or limit tasks that require repetitive thumb action; try using self-opening scissors and garden sheers to limit need for forced thumb extension.
· Avoid lifting heavy saucepans by the handle. Use pot holders with both hands.
· Avoid excessive pinch activities, e.g. using clothes pegs, kitchen tongs.
· Use electrical appliances whenever possible (e.g. can-opener, mixer, processer).
· Try using a jar opener when taking off lids.
· Try purchasing pre-cut and pre-washed fruits and vegetables.
· Reduce time scrolling through mobile phone and texting; use voice activation features.
Baby Care Advice and Precautions
· Avoid picking up your baby with your thumb extended under their armpits. Instead, try scooping them up with your forearm and the palm of your hand.
· When lifting and holding your baby, ensure they are close to your body.
· Use feeding cushions to support breast/bottle feeding your baby so you are not holding the baby with your wrist overly flexed of deviated to one side.
· Support older children (toddlers and older) to climb into car seats and chairs independently
· Ensure a neutral grip of the stroller/pram/walker.
· Opt for a backback style bag over an over-the-shoulder or in-hand bag.
