When you bring a new baby home from the hospital, you bring with them a whole host of new challenges. And a lot of these new challenges involve the repetitive use of your hands – setting up prams, unbuckling car seats, screwing and unscrewing bottle lids not to mention the constant cuddles (aka carrying around a 3+kg bundle) and nappy changes.
However, when we introduce a repetitive movement onto one segment of the body this can cause an overuse injury of the soft tissue. For new mums, the most common overuse condition in the wrist and hand is De Quervain’s.
De Quervain’s is a common postpartum condition affecting the base of the thumb that results in pain, swelling, and weakness due to the sudden increase in demand placed onto the thumb when caring for a new baby.
This condition is a tenosynovitis which refers to excessive inflammation in the lining of the tendons as they pass through the wrist into the thumb. Structurally, there is no damage to the tendon associated with this condition but rather pain due to the inflammation of the tendon sheath.
Around most tendons there is a lining or sheath that protects the tendon as it moves. Tenosynovitis occurs when the lining or sheath becomes inflamed from repetitive movements.
De Quervain’s can be diagnosed by your physiotherapist after an examination of your wrist and thumb without the use of scans or imaging.
As this condition at its core is an overuse condition, the simplest answer to this question is that your wrist and thumb need to be rested to allow the inflammation to settle. However, your duties as a mother cannot simply be placed on pause to allow time for your symptoms to settle.
So instead, physiotherapy employs a few offloading strategies that aim to decrease the pain and inflammation without severely impacting the day to day routine of a mum. This often takes some time (depending on the initial severity of the pain) as the wrist and thumb are still being used.
Wearing a wrist brace that provides support for the tendons of the thumb can help to significantly reduce the load and the pain experienced by the thumb. It is advised to wear the brace throughout the day (as often as is practical) and especially at night to protect the thumb while sleeping.
Placing ice on your wrist and thumb for 10-15 minutes can assist with the pain.
Massage of the muscles in the wrist and forearm can assist with increased muscle tone and pain caused by the repetitive use of your hands. For peace of mind, it is also important to note that surgery is almost never indicated for this condition.
While you can’t stop using your thumb to care for your baby, it is important to try and limit other activities that require the repetitive use of your wrist and hand. This can include use of your phone, writing or typing, and some household
chores.
Be mindful of the position of your thumb when using your hand as some
positions are more strenuous than others. Try to keep your wrist straight when
using your hands and avoid a repetitive pinching grip of your fingers and thumb.
When caring for your baby try to maintain a relaxed neutral grip and try to keep your baby close to your body as you move them into and out of the car/crib/bath to reduce the strain on your wrist and arms. When feeding, you should also try to reduce the work on your arms by placing a pillow across your lap under your baby
so you don’t have to hold all of their body weight and rather support their head.
It is also important to try to change the ways you hold and carry your baby to avoid using the same muscles each time, using a pram or baby carrier can assist with this.
If you have any further questions or are experiencing pain in your wrist and hands, don’t hesitate to contact us for assistance!
