In the early days postpartum, new moms use their wrists and forearms more often than they may recognize: lifting baby from the crib, patting the baby’s back, carrying the heavy car seat and additional baby gear. This, combined with fluctuating hormones during pregnancy and lactation, can lead to “baby wrist.”
Also known as de Quervain’s tenosynovitis or de Quervain’s syndrome, baby wrist is similar to carpal tunnel syndrome. However, carpal tunnel syndrome, which affects many women during pregnancy and the several months after childbirth, is primarily nerve-related, whereas de Quervain’s syndrome is a form of tendonitis.
De Quervain’s tendonitis occurs when two tendons that help straighten the thumb are irritated, constricted or overused. This often happens with new, repetitive activities — like those required in the early phases of parenthood. Hormonal fluctuations contribute to its inception. The syndrome is more common in women than men, and while it is not a dangerous condition it is very painful and requires treatment.
When the tendons at the base of the thumb swell, they put pressure on the nerves, which can lead to discomfort in the wrist and even numbness on the back of the thumb and index finger, caused by irritation to the nerve. De Quervain’s can be tremendously painful for new moms who need to use their wrists so regularly. Pain may be most noticeable when making a fist, turning the wrist or gripping on to something (like a car seat, a diaper bag or a baby!).
The main symptom of de Quervain’s syndrome is pain on the thumb side of the wrist. The pain can creep up slowly or may have sudden onset. Pain may also travel down the thumb or up the forearm, and it generally worsens when using the hand and thumb.
Sometimes this side of the wrist swells, and a resulting fluid-filled cyst may appear. When the thumb is moved, a sensation of snapping or getting stuck may be felt. The pain or swelling may be great enough to decrease mobility in the thumb and wrist. Pinching and similar motions can be particularly painful.
De Quervain’s tendonitis can be diagnosed using the Finkelstein test. Make a fist with fingers closed over the thumb, and bend the wrist toward the little finger. With de Quervain’s tendonitis, this motion is very painful; tenderness is common along the inner part of the wrist below the thumb.
Conservative treatment is recommended for pregnant and lactating women with de Quervain’s tendonitis, as it often resolves itself when breastfeeding ends and hormonal fluctuations cease. Wearing a special brace to stabilize the wrist and immobilize the thumb can treat De Quervain’s syndrome. Anti-inflammatory medications can be administered orally or through injection into the tendons. Acupuncture treatment can alleviate pain.
If these methods don’t improve symptoms, a cortisone injection may be warranted; these have shown 70-90 percent efficacy in curing de Quervain’s syndrome. All of these treatments help reduce swelling and resulting pain. Severe or persistent symptoms may require surgery.
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Reviewed September 6, 2011
by Michele Blacksberg R.N.
Edited by Jody Smith