- ©Donald Sammut 2015
'My experience of De Quervain pain was debilitating. Every time I picked up my 5 month old baby, flexed my right wrist, or used my thumb, I experienced sharp unbearable shooting pain.
The culprits were poor positioning during breastfeeding, and texting with my thumb whilst nursing my baby.
I saw my hand therapist Robyn Midgley 3 times a week for 4 weeks, where she used ultrasound, massage, an ice probe, and a heated bean bag.
I wore a combined wrist and thumb immobilisation splint for 6 weeks and used flexadrin pain relieving cream daily. The splint made mothering my son a little tricky, but I just had to accept help for that relatively short time frame.
I am delighted to say that my wrist is 100% cured, without the need for any cortisone injections or more invasive surgical treatment.' Charisse Plumb
New mom's frequently contact me for assistance with wrist and thumb pain which develops soon after their baby is born. The pain usually begins as a sharp pain, which they tend to ignore. After 3-6 months, the pain in the wrist and thumb usually becomes excruciating and they find it difficult to handle and care for their baby.
These mom's have a condition known as De Quervain's disease. De Quervain's disease is a stenosing tendonopathy or 'strangling' of two of the thumb tendons (APL & APB) that bring the thumb away from the hand. These tendons lie together in a common sheath in the fisrt dorsal compartment of the wrist.
Is it an inflammatory condition?
Contrary to what is believed, the APL & APB tendons in De Quervain’s Disease are normal and do not possess inflammatory cells. However, the fibro-osseous channel has been found to be diminished during cross section of the compartment and fibrotic thickening of the extensor retinaculum is present. In addition, angiogenesis (increased vascularity) is present in diseased tissue.
What causes De Quervain's Disease?
While De Quervain’s Disease is most often linked with over-use injuries, the cause of de Quervains remains unknown. Recent evidence suggests that Prolactin levels (hormone secreted during pregnancy) may increase the risk of developing the disease. The disease is also seen in new fathers, drummers, golfers, racket sports and following trauma such as a direct blow to the tendons.
When experiencing thumb or wrist pain it is important to see a Hand Specialist so that other causes of wrist pain such as a fracture, Osteoarthritis, nerve irritation or Carpal Tunnel Syndrome can be ruled out.
What are the signs & Symptoms:
- Pain and swelling near the base of the thumb.
- Tenderness above the wrist when touched.
- The pain may appear suddenly or may increase gradually over time. Moving the thumb and wrist may aggravate the pain.
- Difficulty with gripping, pinching, squeezing or moving the wrist from side to side, such as when waving.
- Difficulty with lifting or carrying a baby or an object.
- Restriction or “sticking” sensation in the thumb or wrist with movement.
What tests will be performed?
De Quervain's disease can be diagnosed during a clinical examination without the need for specialist investigations. The Finklestein test is a provocative test that is commonly used to confirm the diagnosis.
What can new mom's do to prevent De Quervain's Disease?
- Avoid placing your thumb in an 'L' shaped position when lifting the baby. Rather scoop the baby up by placing your hand palm up on its bottom with your wrist and thumb in a neutral position.
- Be aware of your wrist posture when bottle feeding your baby. Your wrist and thumb must rest in a comfortable, neutral position.
- Be aware of your breast feeding position. Various breast feeding positions could put strain on a mother's wrist, especially when inflammation is already present. Use a pillow for support and ensure that the full weight of baby's head isn't resting in your hand.
- Rest your wrist & thumb. Whenever possible, have your partner lift and carry the baby to give your wrist some time to heal. Limit smartphone use whenever possible.
- Avoid repetitive motions. Do not perform constant motions such as chopping, gardening, drumming, knitting, cleaning, sports motions or texting without sufficient rest periods or stretches.
- Be aware, adapt and avoid: Be aware of any activity that aggravates the symptoms so that those activities can be avoided or adapted.
- Be smart: Purchase ready-peeled vegetables and adapt the way that you use your hands and thumb to perform daily activities. For example if you are reaching and grasping for an item, rather than use your thumb of one hand for support, exclude the thumb by using the palms and fingers of both hands for support.
- Seek help: Contact a Hand Therapist as soon as possible.
Special thanks to Dr Donald Sammut FRCS,FRCS, (Plast.) Consultant Hand Surgeon for his permitting the use of his drawing of a specialist performing the Finklestein test; a provocative test used to clinically diagnose the presence of De Quervain's Disease (www.donaldsammut.com).