De Quervain's Tenosynovitis - a real pain in a new mother's butt
De Quervain’s Tenosynovitis = a real pain in a new mother’s butt.
Butt of the thumb that is.
De Quervain’s Tenosynovitis is pain in the wrist and base of the thumb. And it is one of the most common ‘Mum’ injuries we see as physiotherapists.
I know first hand how frustrating and frankly debilitating this condition can be. I had this pain as a new Mum, after my first born baby, and it was awful. I felt it with every move of the wrist and thumb, including picking up my baby, changing his nappy, lifting the kettle or a bottle of milk…..cutting with knife…..driving…..opening doors. It stank. It really did. And being a physiotherapist myself, it really p*&$ed me off that I couldn’t get on top of it.
One thing I did figure out? The exercises with a rubber band I was giving my Mum patients BEFORE I got the condition myself? They really hurt.
And didn’t help.
So it was back to the drawing board.
In the 12 months of having the condition myself, I learnt SO much about what I could do the second time around to completely prevent it from happening again.
And lucky us, our second baby came along, three years later…..and whaddayaknow……I could feel the tension building in my wrist again just weeks after bringing him home…..the ‘creaks’ were returning (often a first sign).
But I knew what to do. And I got it completely under control. No intervention needed.
And I’m going to share exactly what I did to change things for baby #2.
So first, let’s have the run-down. What exactly is De Quervain’s Tenosynovitis?
A sometimes very painful condition of the lateral wrist (base of the thumb) especially common in new mothers.
Can cause swelling over the thumb side of the wrist, clicking or grinding of the wrist tendons, and difficulty gripping and picking up objects (such as your baby!) or the kettle etc.
Is due to over-loading of the tendons extensor pollicis brevis’ (EPB) and the ‘abductor pollicis longus ‘ (APL), and subsequent inflammation in the tendon ‘sheath’ that houses the tendons.
Generally caused by the daily activities of a new Mum such as picking up and holding their new (growing) baby, combined with ligament laxity leftover from the pregnancy hormone ‘Relaxin’.
Can be prevented if activities are modified from the start.
Changing the the way I:
✔️picked up my baby
✔️carried my baby
✔️breast fed
✔️pushed my pram
✔️used my phone (this was a game-changer)
All helped so much for me.
Last month I posted these three videos on Instagram in a 3 part “Sore Mum Thumb’ series, and the response was amazing! Education is power, and so many Mums contacted me thanking me for these simple pieces of advice that were almost immediately taking the pressure off their sore wrists.
So here they are Mumma, for your viewing pleasure. The original posts were to music so please excuse the weird miming. You get the drift anyway, even if I do look like a bit of a knob.
Part 1
Now in an ideal world, you will be reading this when you are pregnant or with a very new bub, BEFORE you get a sore thumb and can put all of these strategies into place.
The old saying “prevention is better than cure” still stands.
But in all likelihood, if you’re reading this blog, you might already have the condition, and though the change in techniques mentioned above will certainly help, you are most probably looking for some treatment strategies that will give you some relief from the pain.
The first 2 points of call for treatment of De Quervain’s are:
The RICE principal (Rest, Ice, Compression and Elevation- though elevation is not as important here)
Bracing in a specialist De Quervain’s wrist brace*** for your waking hours
Part 2
✔️You can find an example here for relief of more mild pain (if you catch it early)
✔️and here for more severe tenosynovitis
*Braces for this purpose should always have a firm thermo-plastic splint or thumb spica inside to prevent the thumb from moving.
*If you are ever in doubt as to which brace to purchase, see your local physiotherapist. They can also fit the brace for you, and if the splint inside is heat-mouldable, then it is recommended a physio does this part for you.
*There are also custom made splints that specialist hand-therapists can make for you. These will be more expensive, but are exactly that; custom made for you, so in all likelihood will be better quality and more effective in reducing your pain.
Physiotherapist’s and hand therapists (usually specialist trained occupational therapists) also use other techniques to help reduce the load and inflammation of the tendon including;
Part 3
📌 acupuncture /dry needling
🙌🏻 soft tissue release
🎗taping
💪🏻 and exercise prescription
And as always, there is a last resort:
💉 Platelet Infused Plasma (PIP) or cortisone injections
🔪 Surgery
Which all certainly have some degree of evidence of effectiveness behind them ….but let’s hope you don’t need to get to that point. If you can put some preventative strategies in place early on, knives and needles can be avoided!
Let’s get the word out there, please share if you know any new or expectant Mum out there who might find these tips and tricks helpful!
And if you’d like to hear more from me, please subscribe here for more tips and tricks, straight into your inbox.
Learn more about me, Alana Gardini, Physiotherapist here.
And all about my book, My Strong Little Body; A Physiotherapist’s Guide To Nurturing Your Baby’s Development right here.
Love Alana xx
Have you had thumb pain before? What worked (and what didn’t) for you?
References:
Garçon JJ, Charruau B, Marteau E, Laulan J, Bacle G. Results of surgical treatment of De Quervain's tenosynovitis: 80 cases with a mean follow-up of 9.5 years. Orthop Traumatol Surg Res. 2018 Oct;104(6):893-896. doi: 10.1016/j.otsr.2018.04.022. Epub 2018 Aug 23. PMID: 29909297.
Kia C, Baldino J, Bell R, Ramji A, Uyeki C, Mazzocca A. Platelet-Rich Plasma: Review of Current Literature on its Use for Tendon and Ligament Pathology. Curr Rev Musculoskelet Med. 2018;11(4):566-572. doi:10.1007/s12178-018-9515-y