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De Quervain’s Tenosynovitis, colloquially known as “Mommy Thumb”, is a condition where your thumb tendons become very inflamed as they travel from the forearm, through the wrist, and insert on the thumb. This inflammation causes significant pain. The etymology of the condition comes from the Swiss surgeon Fritz de Quervain, MD (1868-1940) who first described this condition and treatment. It is called Mommy Thumb as it happens often in mommies due to the overuse of the thumb in awkward positions while caring for a newborn.
This is one of the most common postpartum conditions that often gets overlooked since new moms usually feel like they have more pressing matters than worrying about thumb and wrist pain. However, it can happen in people who are not mothers and even in people who are not taking care of newborns.
So, what is mommy thumb, why is it so troublesome, and what can you do about it? Read on to find out!
Lifting and holding your newborn, feeding your newborn, or even pushing your baby around in a stroller doesn’t seem particularly hard. However, you might be surprised by the number of times you’ll do this in a day and the unnatural position of your thumb while you do this. The overuse of your thumb, especially in an awkward position (especially with your wrist in flexion), causes the tendons that control some of your thumb’s motion to become inflamed. This inflammation is painful.
In order for the tendons to reach the thumb from your forearm muscles, they pass through a soft tissue (but very unyielding) compartment (or tunnel) on the side of the wrist. This makes matters worse. There is too much swelling and irritation in such a closed space that it compounds the problem and the pain becomes terrible.
So, what does tenosynovitis pain feel like?
If you think you have a mommy thumb, but are not sure, try this: make a fist around your thumb. Put your thumb in your palm and wrap all 4 fingers around it. This might hurt. Now tilt your fist towards your pinky. Very painful? This is the Finkelstein Test and it is the classic test for de Quervain’s tenosynovitis.
The first symptom is pain, often described as sharp or dull. It originates from the base of the thumb or at the thumb side of the wrist. In the worst-case scenario, you’ll feel the pain from your thumb past the wrist and into the forearm. It can be difficult to localize the pain for a layman as it is not a typical pain and it usually occurs suddenly with certain movements.
Another symptom is swelling. If you touch the area, your wrist and thumb will be swollen. This is the enlarged and irritated compartment, or tunnel, the thumb tendons travel through. Sometimes the swelling of the walls of the compartment is so severe that it can feel like a bone or a pebble is in the side of your wrist. This swelling will bring about pain which makes it harder to grab, hold, or pinch things (every activity you use your thumb for), making care for the newborn even more difficult. Difficulty using the thumb is the third symptom.
Finally, when your tendon is so swollen that it can’t support the thumb properly, you may hear or feel clicking. This is the last symptom and this is a result of the swollen tendons and inflammation sliding past each other..
The condition may resolve spontaneously if it does not get severe. However, many modalities can help treat this condition.
Since the issue is inflammation, anything that can help reduce inflammation may help. Ice, rest, splinting, and over-the-counter nonsteroidal anti inflammatory drugs (NSAIDs) can help with both pain and swelling (which itself can cause pain).
Nonetheless, if you suspect you have a mommy thumb, it’s best to see a medical specialist.
We’ve covered some of the most obvious ways to treat mommy thumb. You need to rest and apply ice however, this just won't be enough in some of the most extreme scenarios. Sometimes, you'll have to immobilize the area using a splint. This will allow the tendons to rest without the risk of being unconsciously strained.
Using non-steroidal anti-inflammatory drugs (NSAIDs) can help, and your doctor may even suggest corticosteroid injections to treat the inflammation.
Most importantly, you may be prescribed occupational therapy (physical therapy specialized for the hand and wrist). The OT may involve massage, ultrasound, or even special exercises to stretch and strengthen the area. However, if this does not work, one can opt for a steroid injection. These tend to be very effected and usually have minimal side effects in the perinatal period and can be given during breastfeeding. Talk with your doctor about specific concerns you have to see if this treatment choice is right for you.
If nothing else helps, Quervain’s tenosynovitis can be treated with a more invasive method - surgery. The surgery itself will usually not exceed 10 minutes and can often be done with just numbing the skin - no general anesthesia required.
A surgeon makes a small cut at the base of the thumb on the radial wrist and opens the unyielding compartment (or tunnel) in which the tendons run. Since now the tunnel becomes sort of like a canal, the tendons can move without excessive friction.
The procedure itself is routine, but some complications may occur. Pain, bleeding, skin scarring, and wound infection are risks after surgery. You may also experience some tenderness of the scar, thumb tendons moving out of place, and aching and stiffness. Numbness can also occur. However, these complications are not very common and this procedure usually has a quick recovery without much downtime or large scar.
Since the procedure is minimally invasive, you’ll be released on the same day. You should keep your hand raised and bandaged for the next several days to limit swelling.
This mostly depends on the treatment method applied and the severity of the condition itself.
Still, you must attend regular checkups and follow your doctor’s advice. Also, remember that these are general estimates, and the actual numbers may vary on a case-to-case basis.
Most people won’t ever look up what is mommy thumb before they develop the condition. Once they do, the treatment becomes a top priority, but many people forget about it when the problem is “fixed.”
You must consider activity modification and strengthening the affected area to prevent this. When the supporting muscles and tendons grow stronger, thanks to exercises for mommy thumb, the risk of this problem recurring will be significantly lower.
Some of the most effective such exercises are:
Aside from just doing exercises involving these fingers and tendons, you also want to work on your grip strength (in general) and do a few exercises involving your wrist strength. These are the exercises like:
Generally speaking, these exercises don’t take too long to complete and are helpful, considering you use your hands virtually every daily activity. You should seek the advice of an occupational therapist to review these techniques.
Lastly, most people tend to ignore hand pain for far too long, which, if they persist with usual activities, only makes the matter worse. So, try looking into ‘what is mommy thumb?’ and figure out how to solve the problem. Talk to your doctor and ask for their opinion first. When the pain and swelling are no longer present, you must consider prevention. This usually involves activating and strengthening surrounding areas.
Learn more about mommy thumb or de Quervain’s tenosynovitis and the treatment options available from the experts at the Orthopedic Institute of New Jersey.
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