Many of us do not expect to have aches and pains in our hands, but one condition, de Quervain’s Tenosynovitis, commonly affects women more often than men. At times called “mommy’s wrist” as the condition frequently occurs in moms with newborns. However, this condition has been described widely across all genders and ages.
De Quervain’s tenosynovitis
De Quervain’s tenosynovitis is a condition of the wrist where the tendons to the thumb, which cross the wrist, become inflamed and the soft tissue tunnel thickens. Initial signs of discomfort include radial sided, or thumb-sided, wrist pain, popping when moving the thumb, and numbness or swelling of the thumb. The pain often increases when gripping or rotating the wrist.
Risk factors and causes of de Quervain’s
While de Quervain’s can affect any adult, those at high risk for developing the condition include caretakers, females, those over the age of 40, individuals with a previous wrist injury, and inflammatory arthritis such as rheumatoid arthritis. For new mothers, de Quervain’s is typically seen three weeks after childbirth and results from lifting your child repeatedly and the extra weight bearing strain. Those with occupations that include repetitive movement of the hand are also more prone to this condition due to chronic strain day in and day out.
Think of our tendons like a rope and pulley system. Just as a pulley is designed to support movement and guide the rope, over time, the rope will wear down and not be able to support the load as well. De Quervain’s is similar in that with overuse our tendons cannot glide as smoothly and movement is restricted.
Treatment of de Quervain’s
In terms of treatment, there are a few conservative measures you can take to help calm down the affected area including icing frequently to reduce inflammation, avoid prolonged use of the wrist, and limit straining movements that will worsen the condition.
If the pain persists after trying self-remedies at home, make an appointment with a hand specialist, who can suggest other alternatives. Prior to cortisone injections, your doctor may advise using a thumb spica splint, which is a way to immobilize the thumb, reduce swelling, and ease any discomfort.
Hampton Roads hand surgeon, Nicholas A. Smerlis, MD, FAAOS, CAQSH, of TPMG – Orthopedics recommends cortisone injections as the best and most effective non-operative intervention for treating de Quervain’s.
“This condition is normally solved with time, right around the 6-month mark and with most patients who choose cortisone injections, I see an initial 80% success rate,” said Dr. Smerlis. “In rare cases where injections show little to no improvement, surgery is advised, but patients may try up to 3 cortisone injections.”
Prevention
It is hard to prevent de Quervain’s tenosynovitis, especially in new mothers, but there are a few simple changes that can deliver much needed relief.
Modifications include:
• Using both arms to scoop your baby instead of lifting with your hands in an L-shape
• Avoid holding any static posture for long periods
• Change your actions to reduce stress on your wrist
• Wear a brace or splint to restrict the movement of your thumb and wrist
Most would agree life without the use of our hands would be pretty challenging. We rely on our hands for just about everything and giving them a break is easier said than done. The majority of patients with de Quervain’s tenosynovitis can be treated without surgery. A hand specialist will advise you on the best treatment options available depending on the severity of your condition.
About Dr. Nicholas Smerlis
Nicholas A. Smerlis, MD, FAAOS, CAQSH, is a fellowship trained, board certified orthopedic hand surgeon specializing in the surgical and non-surgical treatment of the hand, wrist, and elbow. Dr. Smerlis brings extensive surgical knowledge to his practice, which continually evolves through practice-based learning. Although he specializes in surgery of the hand, not all problems need surgery, and he often uses non-operative treatments such as medications, splints, injections, and hand therapy to restore function to the hand.
Dr. Smerlis practices at TPMG Orthopedics with offices in Newport News and Williamsburg.
