Mommy Thumb​ - De Quervain's Tenosynovitis

For most new moms it's impossible to avoid picking up their new born.  Unfortunately, holding an infant for prolonged periods can take a toll on your wrists and thumbs.  For example, improper positioning over extended periods of time can lead to a condition commonly known as Mommy Thumb or De Quervain’s Tenosynovitis.  Fortunately, there are some adjustments that a new mom can make to safely hold her baby while protecting her hands.

De Quervain’s tenosynovitis is a common condition that affects the Abductor Pollicus Longus (APL) and Extensor Pollicis Brevis (EPB) tendons, that run through the first dorsal extensor compartment of the wrist. Symptoms can exacerbate during the later months of pregnancy due to increased swelling in the wrist and hand and can further increase postpartum due to lifting and carrying a newborn.

Can I do anything to prevent this from getting worse ?

Activity Modification and Proper Body Mechanics is crucial to prevent and or decrease exacerbation of symptoms.

Modifying the way you hold the baby while nursing or feeding.

Using a nursing pillow alleviates the added stress and weight of the baby in your hands and wrists and allows you to rest the baby on the pillow while the baby is in a proper position.

HUOT Highly recommends My Brest Friend Deluxe Nursing Pillow.

This nursing pillow is a 2019 What to Expect Award Winner! It is known for its wrap-around design that stays secure with an adjustable belt and has a flat surface to prevent the baby from rolling - making it easy for both nursing and bottle feeding moms!

Modifying the Bottle

The shape and size of the bottle nipple can significantly impact flow which is critical for the baby. But, the shape and weight of the bottle is critical to your hands. The smaller the circumference of the bottle and the lighter the weight, the less stress on moms' hands. Thus, when selecting a bottle it is important to be mindful of one that requires a wide grip and increased thumb extension that can be painful when holding for a prolonged period.

HUOT recommends Thinkbaby All-In-One Bottle

This baby bottle is perfectly shaped for moms that are experiencing hand pain while feeding. Its narrow waist prevents hyperextension of mom’s thumb, additionally it is light weight prevents forceful grip and pinch that tend to be painful.

Modifying the way you pickup your baby

Holding your baby is a great bonding time for mom and baby. When holding your baby pay attention to your wrist position while making sure your little one is safe and secure. The optimal wrist position while holding an infant is with the wrist in neutral or as straight as possible. Bending the wrist in either direction for a prolonged period of time can lead to various wrist issues and pain, numbness and or tingling in your hands. Moreover, when picking up your baby try and and avoid hooking your thumb under the baby's arms, rather scoop up the baby in the palm of your hand to more evenly distribute the weight and the pressure on your thumbs.

Take breaks! (Yes, you read that correctly)

In order to properly care for your newborn you need to stay healthy. Whenever possible take short breaks and complete some light wrist stretches in both extension and flexion. Stretches can be performed several times a day. If sore, apply ice to affected area for approximately 5 min to help decrease inflammation.

Perform stretches in a pain free range and contact your therapist if symptoms exacerbate and or persist.

Do you have De Quervain’s?

A quick test that you can do at home to help determine if you are presenting with De Quervain's is the Finkelstein test. In order to complete this test you bend your thumb across the palm of your hand and bend your fingers down over your thumb and move your wrist toward your little finger. Pain with this movement in the radial aspect of your wrist may be a symptom of De Quervain's tenosynovitis.

OK, so you already made all the recommended modifications and you are still in pain? What's next?

There are various treatment options available for patients presenting with De Queurvain's.

Conservative Options 

• Occupational Therapy/ Hand Therapy
• Modalities for pain control
• Manual therapy
• Therapeutic exercise
• Therapeutic Taping
• Splint Immobilization

A Forearm Based Thumb Spica Splint to immobilize the wrist and thumb and allow the tendons to rest by avoiding repetitive movements is recommended for treatment.

Your doctor may recommend over-the-counter anti inflammatory/ pain relievers. Additionally depending on the symptoms, your physician may recommend injections of corticosteroid medications into the tendon sheath to reduce swelling.

In acute cases where treatment is initiated within the first 3-6 months patients respond well to conservative treatment.

Surgical Options

Depending on the severity of your symptoms, your doctor may recommend surgery. A De Quervain's release is an outpatient surgical procedure in which the surgeon identifies the tendon sheath of the first dorsal compartment and then opens the sheath to release the pressure so your tendons can glide freely.

Post-operatively your surgeon may refer you to therapy. Your occupational therapist will work with you to regain your range of motion, complete scar management techniques as well as strengthening exercises to help you resume your daily activities symptom free.

Fortunately, there are a variety of options available. If you have any questions or would like to schedule an appointment with the HUOT Team please contact us today. We treat patients at all stages from acute exacerbation to post-surgical cases and fabricate same day light weight custom orthotics/splints. We are looking forward to working with you so that you can resume holding your little one pain free!

The information provided above by no means replaces the evaluation of a skilled therapist & physician. These are general recommendations. If you have symptoms and can benefit from a formal evaluation please contact Hands Up Occupational Therapy.