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Harvard Commentaries
35320
Harvard Commentaries
Reviewed by the Faculty of Harvard Medical School


Woman to Woman Woman to Woman
 

New Moms: Welcome Relief from Hand Pain


January 14, 2013

By Alice Y. Chang M.D.

Harvard Medical School

When my right wrist began to hurt, I assumed it was carpal tunnel syndrome, a condition caused by inflammation of the tendons that pass through the wrist. Since new mothers like me are often prone to this condition, it was a natural — but wrong — self-diagnosis.

Doctors often neglect or dismiss their own health problems, and I'm no exception. As a busy working mom, I depend on caring and observant family, friends and co-workers to remind me when I'm neglecting myself. Even when colleagues told me to see a doctor, I kept saying, "I am a doctor." I figured ice, ibuprofen and a brace were the only remedies available. But the pain continued to interfere with many of my activities at home and work. Most of all, it broke my heart when I couldn't pick up my son after a long day at work. Now I want more women and physicians to know about this potentially overlooked diagnosis and how to fix it.

A wise physician and mentor, who is also an experienced father and grandfather, made the right diagnosis after one quick glance at my wrist brace. "You know what that is, don't you?" he asked. I quickly said, "Yes, carpal tunnel syndrome." He patiently replied, "No, it's de Quervain's tendonitis. They say new mothers and grandmothers often get it from repeatedly picking up a baby or child. My wife had it. But an injection fixed it."

That last comment got my attention. There was something more that could be done! I made an appointment with a doctor and within a week, I was rescued from pain. It was a miracle. I now put this rheumatologist on a pedestal next to the anesthesiologist who gave me my epidural when my son was born!

The inflammation and pain caused by de Quervain's tendonitis is similar to other types of tendonitis caused by overuse. But two things make it unique: its location (the base of the thumb) and who it affects (new mothers). In carpal tunnel syndrome, pain is usually centered on the inside of your wrist where nerves and tendons pass through a narrow tunnel-like space. De Quervain's tendonitis, however, involves just the thumb tendon, which runs through a canal at the base of the thumb at the back of the hand.

The common teaching is that people who do a lot of work with their hands, particularly those who do needle and computer work, are susceptible because of the repetitive movements of their hands and thumbs. But what medical textbooks never told me is that it commonly occurs in new mothers or grandmothers who are more likely to repeatedly pick up their first child or grandchild.

Signs you may have de Quervain's tendonitis:

  • Pain or swelling on the thumb side of the wrist, on the back side of your wrist
  • Increased pain when forming a fist, grasping, holding things or turning the wrist
  • A snapping or catching feeling when moving the thumb (a type of trigger finger)

How de Quervain's tendonitis is diagnosed:

    • Pain during a Finkelstein test — Make a fist, folding your fingers over your thumb. Carefully bend your wrist in the direction of your little finger. Pain at the base of the thumb makes a diagnosis of de Quervain's tendonitis very likely.

 

  • Tenderness in the "anatomic snuff box" — When you spread out your fingers, extending your thumb towards the back of your wrist, you will notice a V-shaped area at the base of your thumb. If it's very painful when you push inside here, you may have de Quervain's tendonitis or a fracture.

A health care professional might want to check an X-ray of your wrist to make sure it isn't a fracture.

What you can do:

    • Avoid or limit activities that hurt. This is easier said than done for mothers caring for infants and young children or people who use their hands for work outside the home. Use the other hand as much as possible.

 

    • Find the right wrist brace. Using a wrist brace that supports and rests the thumb can ease pain. It's also a reminder to avoid using that wrist if possible. If you can't find the right one in a medical supply store or pharmacy, see your health care provider to have a special splint made.

 

    • Apply ice. When the baby is napping or during a work break, ice the back of your wrist for 5 to 15 minutes a few times a day. You'll be surprised how much this helps.

 

  • Take NSAIDS (nonsteroidal anti-inflammatory drugs). An over-the-counter medication like ibuprofen or naproxen, taken as directed, can help reduce inflammation. If you're breastfeeding, talk to your baby's pediatrician before you take ibuprofen or naproxen because a small amount of the medication can pass into breast milk.

How a health care professional can help:

    • Corticosteroid injection — If the above techniques don't work, a cortisone-like or steroid injection can be extremely effective at relieving inflammation and pain. It's usually much more effective for de Quervain's tendonitis than other types of tendinitis because the inflammation is limited to a very small space.

 

  • Surgery — In severe or recurring cases where self-care treatments and injections don't work, surgery can open up the channel where the tendons pass from the thumb.

Summary

Busy moms can't afford to be sidelined by hand pain. If you notice a new mother or grandmother favoring one wrist, ask her to touch the area at the back of her wrist, just below the base of the thumb. If it's tender, chances are she has de Quervain's tendonitis. When home treatments fail, see a health care professional. A corticosteroid injection can quickly relieve the pain and accelerate the healing process.

Alice Y. Chang, M.D. is a former instructor in medicine at Harvard Medical School. She is currently associated with University of Texas Southwestern Medical Center. Her clinical interests and experience are in the fields of primary care, women's health, hospital-based medicine and patient education.

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