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De Quervain’s Tenosynovitis in pregnant women and new mothers
Pregnant women or breastfeeding mothers have hormonal changes different from non-pregnant women. The hormones cause body fluid accumulation, especially in their wrists and hands, resulting in a water-logged and swollen tendon sheath. Moving wrists and hands causes rubbing of the tendon against its sheath, most often at the base of the thumbs and wrists. After giving birth, using their wrists to hold their babies for breastfeeding will lead to a higher risk of developing de Quervain’s tenosynovitis.
De Quervain’s tenosynovitis is common in pregnant women, new mothers, and the elderly.
The other 2 conditions pregnant women or new mothers often face are trigger finger and carpal tunnel syndrome (numbness in the thumb, index, and middle fingers because of wet and swollen tendon sheath pressing on a nerve in the wrist.)
Signs and Symptoms
- Wrist pain, mild to severe, near the base of the thumb causing insomnia.
- Pain when stretching and bending the thumb.
- Swelling and mild inflammation in the thumb side of the wrist.
Preventions
- Avoid using your wrists during pregnancy, e.g., lifting heavy objects.
- Avoid using your hands after pregnancy and breastfeeding. Lock your wrists in a robot-like motion to reduce wrist movement when feeding or bathing babies.
Diagnosis
- Tender at the base of the thumb
- Finkelstein’s test is positive when mild to severe pain is reported. To do the test, flex your thumb into the middle of the palm. Bend the other four fingers to cover the thumb and bend your wrist toward your little finger. You will feel the pain. Some may be afraid of bending their wrists again.
Treatment
- Minimize using your wrists and thumbs; use them when necessary, and flex them slowly.
- Wear wrist and thumb splints.
If the pain persists and worsens to the point your daily routine is affected, doctors may consider steroid injection. The pain usually resolves after the treatment. Most of the time, only one injection is enough. For breastfeeding mothers, however, there is a minimal chance the condition may relapse in a few months requiring a second injection. (An orthopedist should perform the steroid injection to prevent injection into the tendon. The steroid injection should be in the narrow space between the tendon and tendon sheath. An experienced orthopedic hand surgeon with deep knowledge of hand anatomy can do a much safer steroid injection with increased accuracy when guided by ultrasound.)
