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MUMMY'S THUMB- De Quervain's Tenosynovitis

"THE GOOD RULE OF THUMB IS TO ASSUME THAT EVERYTHING MATTERS."


You don't know how importan your tumb is until you cannnot grasp a glass. It was about a month or so after delivery, when I started to feel the pain in my wrist. Every time I tried to grasp something I had this sharp pain around my thumb...don't even want to remember how it felt every time I picked up my baby...and in the morning...I couldn't even use my hand for the first hour after waking...


Have you watched "Scary Movie 2", turkey scene with a butler? Do you remember his hand?


Scary movie 2

My hubby said that my hand look's just like his...sexy, right...


However, as funny as it was at first, the pain was getting worse, and I had tough times carrying a baby and doing simple daily tasks.


That's when I decided to knock on doctor's doors...diagnosis: "De Quervain's tenosynovitis" aka "Mummy's thumb".


WHAT IS MUMMY'S THUMB?


Mummy's thumb is known by its medical name de Quervain's tenosynovitis. It's a painful condition affecting the tendons in the thumb, that run down the side to the wrist.[1]


It's claimed that is more apparent in these »modern world« because women do not do rigorous hand activities such as kneading bread and washing by hand, as much as they used to.


WHAT'S THE CAUSE?


Chronic overuse of your wrist is commonly associated with de Quervain's tenosynovitis.[2]


The repetitive hand or wrist movement may irritate the sheath around the two tendons (in your wrist and lower thumb) causing them to thicken and swell, which restricts their movement.


Other causes:[3]

  • Direct injury to your wrist or tendon; scar tissue can restrict the movement of the tendons

  • Inflammatory arthritis, such as rheumatoid arthritis


SYMPTOMS OF DE QUERVAIN'S TENOSYNOVITIS[4]

  • Pain near the base of your thumb

  • Swelling near the base of your thumb

  • Difficulty moving your thumb and wrist when you're doing something that involves grasping or pinching

  • A "sticking" or "stop-and-go" sensation in your thumb when moving it


WHY IS IT CALLED MUMMY'S THUMB?


The condition is more prevalent in women than men, and it may be associated with pregnancy.[5]


"I WAS TOLD THAT THE ONLY REMEDY AT THIS TIME WOULD BE PAIN KILLERS AND INJECTION."

The good news is that this condition responds well to conservative management.

One study compared steroid injections with splinting and found that the injection group had immediate relief from pain, but the splitting group also had relief of pain.[6]


Another study compared the efficacy of conservative management of de Quervain's disease in 30 women postpartum and 30 nonpregnant women. Patients were treated conservatively with 2 weeks of protective splinting, immobilizing the wrist and thumb, followed by hand therapy and anti-inflammatories. Conservative management gave good results in postpartum women with only one patient requiring surgery. On the other hand, 25 women in the nonpregnant group required surgery due to the failure of conservative management.[7]


Hormones in postpartum women make women more susceptible to injury.


WHY?


Elevated levels of prolactin in nursing mothers cause ligaments to be laxer.

The position of the wrist and thumb when nursing, duration of nursing as well as the repetitive strain from tasks associated with motherhood may put a larger strain on the tendon sheaths.


It is important for pregnant women and new mothers to be acknowledged about this in the context of prenatal education classes. Unfortunately, most of these classes fail to mention this, as the focus is on the baby's needs. However, a well-educated coach will let you know about it in your pre or postnatal class (hopefully!).


It is important to be aware before you experience any of the symptoms or develop »bad habits« when caring for her infant. Putting off the treatment may have a negative effect on your outcome.


WHAT CAN YOU DO IF YOU EXPERIENCE »MUMMY'S THUMB«?


Use the pillows that have been specifically designed for breastfeeding, to take the pressure oof your arm to hold a baby close to you.

If needed you can also use a forearm based thumb spica splint to position the wrist and thumb in neutral can also be worn while breastfeeding.


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REFERENCE:

[1] [2] [3] [4] Goel, R., & Abzug, J. M. (2014). de Quervain's tenosynovitis: a review of the rehabilitative options. Hand (New York, N.Y.), 10(1), 1-5. doi: 10.1007/s11552-014-9649-3

[5] Schned, E. S. (1986, September). DeQuervain tenosynovitis in pregnant and postpartum women. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/3488531

[6] Avci S, Yilmaz C.,Sayli U. Comparison of nonsurgical treatment measures for de Quervain's disease of pregnancy and lactation. Jhnad Surg Am.2002 Mar;27(2):322-4

[7] Capasso, G., Testa, V., Maffulli, N. et al. International Orthopaedics (SICOT) (2002) 26: 23. https://doi.org/10.1007/s00264-001-0302-8