Post Partum wrist pain- what can be done?

As moms we all know how demanding caring for a baby can be. What can often complicate the situation is the development of various aches and pains that can arise postpartum as a result of caring for your baby. One of these problems is the development of wrist and/or thumb pain which is medically termed: De Quervains Tenosynovitis

What causes De Quervains Tenosynovitis ?

De Quevains is caused by an increase in repetitive, novel hand and wrist movement that up until now, our hands never had to do! The specific movements which causes this condition is gripping with an extended or abducted thumb. This is often seen in movements like lifting, bottle feeding or pushing a stroller (Figure 1A and B). The Thumb tendons (namely the Abductor Pollicis Longus and Extensor Pollicis Brevis) that are responsible for the above movements are surrounded by a facial sheath. Repetitive motion leads to repeated gliding of these tendons in the sheath.  Frictional mictrotrauma from the repeated gliding may lead to tendon sheath inflammation, chronic thickening and pain (ref)

Figure 1 A

Figure 1B

What are the signs and symptoms of De Quervains?

• Pain and often swelling just above the radial styloid of the wrist (near base of the thumb).
• Pain is usually worse during activities and better when rested, however when severe, pain can be felt at rest and even disturb sleep
• Morning stiffness and pain may also be a feature
• Painful Finkelsteins test (ulnar deviation of the wrist with thumb adduction -see Figure 2)

Finkelsteins Test for De Quervains

How can Physiotherapy help De Quervains

De Quervains is one of those conditions, which physiotherapy treats successfully

Treatment includes

• Splinting or taping of the hand to offload painful structures
• Advice about how to modify caregiving in order to rest painful structures
• Soft tissue work to the muscles attached to the involved tendons
• Acupuncture to improve pain and decrease swelling
• Specific exercises to increase strength of the involved tendons

If physiotherapy is unsuccessful, doctors may suggest a period of non steroidal antiinflmmatory drugs and if that doesnt work a steroid injection into the painful area