De-Quervain's Syndrome

De-Quervain's syndrome refers to pain at the bony prominence at the outer side of the wrist (the thumb’s side rather than the little finger’s side). It is common during the post-natal period. That's why it is also called mummy's wrist. Hormonal changes, as well as increased use of the wrist and thumb contribute to the development of pain. It can also occur during other phases of life, and in males as well. 

The source of pain is the tendons that control the thumb movements. A tendon is an extension of the muscle. The muscles that control the opening of the thumb originate from the forearm. The tendon of these muscles pass through the outside of the wrist, and sticks onto the base of the thumb. When the muscles contract, tendons transmit the force and thus moving the thumb.

For De-Quervain's syndrome during late stage of pregnancy or post-natal period, hormonal changes play an important role. Hormonal changes are extensive during pregnancy and breastfeeding time. These changes lead to mild swelling in the tendons. Around the tendons, there are tough structures, called ligaments, that bind the tendons down to the bone at the wrist. They form a tunnel-like structure that the tendons have to glide through when moving the thumb. When the tendons get swollen due to hormonal changes, the space in the tunnel maintains the same. Therefore it becomes much more difficult for the tendons to glide through, and the gliding of the tendons gradually become painful.

Hormonal levels will only go back to normal several months after breastfeeding ends. Therefore, some moms only experience complete relief of the symptoms by that time. While we cannot do much about hormonal changes, we can reduce the pain by modifying wrist and thumb postures to minimize irritation to the tendons.

For De-Quervain's Syndrome that occurs out of the pre- and post-natal period, excessive movement of the thumb and wrist places excessive stress onto the tendons. These tendons gradually thickens, and gets irritated as they have to keep gliding through the narrow tunnel at the wrist.

To reduce pain, these tendons need to be allowed to rest. This is achieved through minimizing thumb movements. We need to keep the thumb at the side of the palm as much as possible. For example, when picking up an infant, it is better to form scoops with our hands, with the thumbs sticking to the outside of the index finger, and scoop up the baby. When carrying toddlers from the floor, squat and hug the kid to carry him/her up, instead of opening the thumbs to pick up the kid from under the armpit.

When reaching for smaller objects, such as cups and bottles, try to minimize the movement of the thumb by keeping it to the side of the palm. It may take some time to get used to these new movement patterns. If pain is severe, one may use a thumb brace to restrict thumb movements. The brace can be worn during the day when the hands are frequently used. It can also be worn at night if the pain disturbs sleep. 

Acupuncture also provides good pain relief for most patients. In more severe cases, a steroid jab can be administered by a hand surgeon for better pain relief. Occasionally, when all measures fail, surgery may be required.