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Dealing With Mummy Thumb: De Quervain’s Syndrome

Mummy Thumb is the current nickname given to De Quervain’s syndrome. Almost 50% of new mothers experience this condition.

However, it is a condition common to many people who engage in repetitive hand or wrist movement, such as gardening, knitting, cooking, playing a musical instrument, carpentry, lifting a baby, and the like.

De Quervain’s syndrome (also known as De Quervain’s tenosynovitis) occurs when the tendons around the base of the thumb are irritated and constricted. Specifically, the protective synovium sheath of the tendon becomes inflamed. In most cases, the condition is not serious and can be easily treated.

What Causes De Quervain’s Syndrome?

When you grip, grasp, clench or pinch anything in your hand, you use two major tendons in your wrist and lower thumb. These tendons run side-by-side from your forearm through the thumb side of your wrist. They normally glide unhampered through the small tunnel that connects them to the base of the thumb. In De Quervain’s syndrome the tendons’ sheath becomes inflamed, restricting movement of the tendons. It is the inflammation of the tendon sheath that causes pain.

It is common for patients to develop this condition following a sudden increase in activities that places stress on the thumb tendons, these may include: sports such as golf, racquet sports, ten pin bowling, rowing or canoeing, general gripping activities, carrying, lifting, or typing, playing of a musical instrument like a piano or guitar. De Quervain’s syndrome occurs as a result of the overuse of the wrist and thumb, i.e. repetitive motion. Because up to 50% of the hand’s function relates to the thumb, symptoms can significantly interfere with everyday functions.

Why Mother (& Fathers) are Affected

It has been determined that Mummy Thumb occurs when infants are lifted improperly. A mother may describe it as a sharp, shooting pain starting at the thumb, through the wrist, and darting up the forearm.

This improper lifting affects up to 50% of new mothers.

How it happens:

Many mothers reach down and place their thumbs in their child’s armpits to lift them. This causes extra strain on the thumb and tendons. The heavier the child is, the more likely this condition will occur. In addition, hormonal changes associated with nursing and pregnancy can contribute to weaker thumbs and wrists. The repetitive motion of placing the thumb and index finger in the shape of an “L” to lift young children causes the pain and inflammation. Similarly, cradling the child with the L-shaped thumb and index finger beneath its head can also cause discomfort, as can other awkward hand positioning when carrying a baby.

The proper way to lift a child:

Mummy thumb can be avoided by changing a few of your habits. When picking up your child, do not use your thumb and fingers. Instead, place your hands on both sides of their rib cage and gently squeeze the child to lift. Or, place one hand under the child’s bottom and one behind their head to lift the child. Make sure you aren’t bending down farther than necessary. Remember to use your legs to lift heavier children and avoid bending the back or stooping while lifting your child.

Other Causes

Although the primary cause of De Quervain’s tendonitis is overuse, there are other possible causes associated with aging, disease, or direct injury:

  • Direct injury to the wrist (such as a fracture) or tendon that causes scar tissue to build-up and restrict movement of the tendons.
  • Inflammatory arthritis, such as rheumatoid arthritis.
  • Metabolic conditions such as diabetes, hyperuricemia, hypothyroidism.

Symptoms of De Quervain’s Syndrome

The common complaint of De Quervain’s syndrome is a pain and swelling near the base of, or over the thumb. The pain may appear suddenly or may increase over time, spreading farther into the thumb and wrist, and up the forearm. Pinching, grasping, lifting and other movements of the thumb and wrist aggravate the pain.

Diagnosis

A thorough subjective and objective examination from one of our physiotherapists is usually sufficient to diagnose De Quervains syndrome. Further investigations such as an X-ray, Ultrasound, MRI or CT scan may be required to assist with diagnosis and assess the severity of the condition.

Treatment

One of the key components of treatment is that the patient rests sufficiently from any activity that increases their pain until they are symptom free. Once the patient can perform activities pain free, a gradual return to these activities is indicated provided there is no increase in symptoms.

Ignoring symptoms or adopting a ‘no pain, no gain’ attitude is likely to lead to the problem becoming chronic. Once the condition is chronic, healing slows significantly resulting in markedly increased recovery times and an increased likelihood of future recurrence.

Patients with De Quervain’s syndrome will usually benefit from:

  • Limit and avoid activities that may directly aggravate thumb and wrist discomfort.
  • Apply ice or cold packs for 15 minutes to affected hand several times a day.
  • Modify lifting activities e.g. lifting of an infant.
  • Use ergonomically designed tools such as kitchen, gardening or handyman tools.

Professional Help

If pain symptoms of your thumb that you are managing yourself have not improved after a few days, it is best to seek medical advice and consult with one of our physiotherapists at Jubilee Sports Physiotherapy to get an accurate diagnosis of the injury and suggest the most appropriate treatment plan.

Physiotherapy Provides Rehabilitation and Support

Most cases of De Quervain’s syndrome settle well with appropriate physiotherapy. Surgery is always the last resort. However, treatment success is largely dictated by patient compliance. Treatments may include:

  • Hands on therapy such as massage and joint mobilisation to the wrist, thumb and hand can assist with hastening healing and improving flexibility and function.
  • Rehabilitation exercises such as wrist extension and flexion, and supination and pronation of the affected forearm, but only if these do not cause further discomfort or pain.
  • A stretching program can be started as soon as symptoms allow to encourage full range of pain-free movement.
  • A brace or splint may be prescribed to offload the overused tendons.

For more information regarding management and prevention of De Quervain’s syndrome contact one of the physiotherapists at Jubilee Sports Physiotherapy.






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