15 Feb Wrist Pain in Mommies
Often new moms (and old moms) complain of pain on the thumb side of the wrist. This particular pain can be reproduced by placing the hand in a ‘thumbs up’ direction, then tucking the thumb into the palm, clenching the rest of the fingers around it and dropping it to the floor (see the first photo). This pain is a type of tenosynovitis (inflammation of the tendons and surrounding joint fluid) called DeQuervains’.
DeQuervain’s tenosynovitis is a very common wrist injury in new moms or those who do manual repetitive lifting labor. Since moms do repetitive manual labor they suffer from this more readily! Think lifting an infant again and again and again…out of the crib, into the crib; up on your shoulder to burp, down from your shoulder to burp; onto the changing table, off of the changing table….you see my point here.
Because the thumb side of the wrist is usually the one facing up, it is the driving force of the wrist movement upwards and then when lowering it also works to slow down the movement of the wrist. This motion when it becomes repetitive angers the two tendons of thumb. Both of these tendons happen to sit in an area encased in a tissue sheath, so when the friction becomes too high due to overuse, inflammation begins to crowd the sheath and fluid gets trapped in the area. This is what we call tenosynovitis. It is different from tendonitis (the inflammation of a tendon) because it is the inflammation of a tendon (-teno) along with edema in the tendon sheath (synovitis). These types of tendonitis’ are always the most difficult types of tendonitis to get rid of because of the synovitis factor.
Thus tenosynovitis anywhere in the body needs aggressive treatment or it will continue and become chronic.
DeQuervains presents with pain on the thumb side of the wrist, pain being worse on movement, such as lifting or any deviation of the wrist in a thumb-upward manner. Think lifting your child out of a crib or more subtle than that, lifting a coffee cup to drink.
Aggressive treatment must first be to shut down the motions causing pain. This is most difficult as new moms cannot simply not lift their newborn. However, if you don’t avoid loading positions the swelling, friction and thus the pain will not subside. For this reason the first order of business if you cannot stop using the wrist is to invest in a good wrist brace. Do not bother with strengthening of the wrist as many websites and physical therapist will have you do. This will get you nowhere.
1. Wrist splint with thumb spica
There really is no getting around this one. The best way to try to battle tenosynovitis is by wearing a brace. Imagine if I have an overuse injury and I keep using it, the injury will never go away. Its like having knee pain every time I run. If I continue to run, the pain will not go away. The splint provides protection and support to the injury when you cant simply stop using the wrist…and moms with infants simply cant stop using the wrist! Wear it during the day and at night. That said, you don’t, however, want to wear it 24/7. You should be taking it off periodically when you are not using the wrist so that you can stretch and move the wrist in a pain-free fashion. Keeping it on without removing can make the wrist too tight. You need to strike a balance. Therefore, take it off when you are not using the wrist for any loading or lifting.
2. Stretch:
Tuck the thumb into the palm of the hand. With an outstretched arm push the wrist towards the floor as the picture shows
The most important thing to remember is that this stretch can be done only in a pain-free fashion. If there is pain with the stretch do not do it, or better yet make the movement smaller and only go as far as you can stretch with NO PAIN at all…even if this means you are getting very little movement. Any pain with the stretch will aggravate the injury.
Try this for 10 seconds at a time as often as you can as long as you are not going to the point of discomfort.
3. Avoid any movement that causes pain
4. Ice: 10-20 minutes several times a day
5. Massage/Physical Therapy:
One of the best things you can do for tenosynovitis is massage and manipulation of the joints and gliding of the tendons. This helps the inflammation to disperse out of the sheath and decrease the friction, thus lessen the pain. A physical therapist can do this readily.
Combining all 5 of the above will help resolve this problem quicker. However, without listening to #3 , it will be impossible to lessen pain. So if you cannot do #3, make sure you are very good about #1!!