Wrist pain from your baby?

In addition to painful breasts, a sore episiotomy, sleepless nights, mood swings, and additional weight, there is yet another post-partum ailment that afflicts new mothers: wrist pain.

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: it's 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 thinking 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)

de Quervain's tendonitis is diagnosed using two tests. In one called a Finkelstein test, you 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. Another test checks for 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.

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 also serves as 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 (Non-steroidal anti-inflammatory drugs). Taking an over-the-counter medication like ibuprofen or naproxen 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.

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. 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.

Busy moms can’t afford to be sidelined by wrist 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.

Do you know anyone who has suffered from this ailment? While rare, it is good to know that wrist pain may be an occupational hazard of caring for a little one.

Dr. Victoria McEvoy graduated from Harvard Medical School in 1975 and is currently an Assistant Professor of Pediatrics at HMS. She is the Medical Director and Chief of Pediatrics at Mass General West Medical Group. She has practiced pediatrics for almost thirty years. She has been married to Earl for thirty six years and raised four children. She currently enjoys writing, traveling, reading, almost all sports, and spending time with her two grandsons.

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