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Pregnancy—thumb and wrist pain

Thumb and wrist pain during and after pregnancy—De Quervain's tenosynovitis

In De Quervain's tenosynovitis, the covering of the tendons on the thumb side of the wrist becomes inflamed or swollen, restricting the tendons' movement. The result is discomfort and pain at the base of the thumb and wrist every time you turn your wrist, grasp anything or make a fist.

It is suspected that retention of fluid during pregnancy initially causes this problem, and symptoms generally start quite mild. It is frequently aggravated by activities of infant care and housework causing it to linger and, often, make it worse. In some cases it can be so painful that hand movements are restricted.

Improvement usually occurs with conservative management, and it is best to see a physiotherapist early on to commence treatment. It is rare for this condition to require surgical or other medical management.

Signs and symptoms

  • Pain, tenderness and swelling at base of the thumb and wrist.
  • Pain that may radiate up your forearm.
  • Pain when you turn your wrist, grasp or make a fist which can lead to difficulties with picking up your baby, or holding your baby to settle.
  • Difficulties picking up objects where thumb pressure is required e.g. picking up a plate of food.
  • Gardening, knitting and cooking e.g. peeling, stirring.

What can I do about it?

Rest

This is the most effective treatment so try to avoid using your hands and wrists when you can.

Splint

This is often recommended, to immobilise your thumb/wrist, and help rest your tendons. This can be fitted and purchased from the physiotherapy department or an individual splint can be made by the occupational therapy department.

Modify your activities

  • Avoid repetitive movements and sustained positions
    • Carry things with a shoulder bag or over your forearms, not your hands
    • Avoid over-gripping when using equipment.
  • Breastfeeding position
    • After your baby is born, try to use pillows to take the baby's weight off your hands when feeding or cuddling.
    • Do not use your hand to support your baby's head; use your forearm instead.
  • Housework and daily activities
    • Ask for help with food preparation, especially when using knives, etc. Remember you can buy pre-cut, pre-washed fruits and vegetables.
    • When brushing your teeth or your hair, try to move from your elbow instead of from your wrist.

Massage

  • Gentle massage might help ease some of the pain. Use your thumb to gently rub the upper half of your other forearm where the muscles are. You can do this as often as you need.
  • If massage helps, ask your support person to do this for you, to help rest your hands.

Contrast bathing

  • Set up two bowls; fill one with very warm (NOT scalding) water and one with iced water. Bathe your hand/wrist in one bowl for about 30 seconds, then in the other for 30 seconds. Alternate between the two bowls for three minutes and finish with the cold water.
  • This can be done as often as you need to relieve symptoms.

Pain relief medications

Check with your pharmacist or doctor about pain relief. If you are pregnant or breastfeeding or have a medical condition talk to your pharmacist or doctor before taking any medication, even herbal remedies.

Exercises

Different women find different remedies helpful.
Try the following hand exercises, but do NOT continue if symptoms become worse:

  • Hold your fingers stretched out as far as possible for a few seconds and then relax.
  • Make a fist and then straighten out your fingers.
  • Move your hands slowly up and down, from side to side, and round in a circle.

Your physiotherapist can prescribe further exercise (strengthening and mobility, nerve and tendon glides) and sometimes electrotherapy (e.g. ultrasound) if required.

Further information

For further information or to make an appointment with a physiotherapist please phone Mater Mothers' Hospital Physiotherapy (Allied Health Reception) on 07 3163 6000.

Mater acknowledges consumer consultation in the development of this patient information.
Last modified 17/11/2015.
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