New mum’s painful thumb

New mums are busy - life is full on and focussed - and all about a little person who absorbs all your time (and energy). Sometimes a big change in how you are using your hands causes a problem with tendons of your thumb - a condition called “deQuervain’s”.  deQuervains occurs when two tendons to your thumb become aggravated as they cross your wrist producing pain and tenderness. It hurts to make a fist, pick up objects, holding your baby, breastfeeding, changing nappies, even putting on a seat belt. This obviously is a problem.

The tendons involved in deQuervains move your thumb out from your hand but also work on your wrist so that you can do a side to side movement. The combination of repetitive movements of both thumb and wrist, increased fluid or swelling and hormonal changes can contribute to developing this problem. 

What actually happens?
These thumb tendons become aggravated where they run through a compartment or tunnel the side of your wrist (photo). The lining of the compartment (called synovium) swells and reduces the space the tendons have, which makes the normal gliding movement difficult. The tendons themselves then become thickened which increases the friction and compounds the problem. 

Symptoms include:
Pain and tenderness on the thumb side of your wrist
Swelling or thickening in this area. 
Sometimes pain radiates up your forearm
Difficulty with pinch and gripping activities.

There are a couple of tests we use to diagnose deQuervains. One is Finkelstien’s test where the tendons are put on stretch, which results in pain. Ultrasound imaging can be helpful to determine thickening of the two tendons involved and the little tunnel they run through at the level of your wrist.

Can this be treated? 
Treatment starts with splinting, compression to reduce swelling, teaching  you how to look after your thumb and reduce the aggravation. Heat packs & massage can also really help to reduce pain.  You can expect to use a splint for any painful activities for about 4-6 weeks, although if your pain reduces quickly, we would free your hand up more quickly. Taping or a neoprene support can be useful in this process. 

If hand therapy alone doesn’t work well for you, a cortisone injection may be suggested by your GP. Otherwise a referral to a specialist for surgical opinion is considered if other treatment isn’t successful. 

The good news is that the earlier you seek expert treatment the more quickly you recover. And best of all, almost all new mums with deQuervains recover completely.