Look Ma, No Hands! De Quervain’s Tenosynovitis and the New Mom

When I was a new mom, the thing I wanted more than anything else was a working set of opposable thumbs. I wanted to pick up my magical bundle of daughter without yelping in pain. I wanted to change a diaper without deliberately hurting myself. But every mom plays the cards she’s dealt, and my hand to play was to learn how to play without my hands.

During pregnancy, I developed a severe case of bilateral De Quervain’s tenosynovitis. My life with an infant was very different than I had imagined.

First off, if you are currently pregnant and landed on this blog post by Googling “hand pain pregnancy”, DO NOT PANIC. My case was extreme, and in general De Quervain’s is not a common occurrence in pregnancy and early motherhood. See your doctor. I am writing this post for the me of the past, who memorized every website that mentioned De Quervain’s and vainly looked for community. Hey you, pretty pregnant lady with the immobilizing arm braces. I see you. It’s going to be okay. You’ll figure this out and be a great mom.

De Quervain’s tenosynovitis is the painful inflammation of the tendons that operate the thumb. This causes friction whenever the patient pinches or grasps using the thumb, makes a fist, or twists the wrist in certain directions. The pain can be sharp and intense. De Quervain’s can be caused by injury to the tendons, overuse (sometime called “texting thumb”), or…pregnancy and nursing. The exact reason for this association with new moms is unknown, but there is some evidence that the hormonal changes of pregnancy and nursing cause swelling which trigger the De Quervain’s tenosynovitis. Sometimes mothers develop De Quervain’s postpartum – in years past this was called “mother’s wrist”, and is associated with the constant strain of lifting and carrying a baby or toddler.

In my case, my doctors believe the condition was caused by hormones. In my second trimester I began experiencing hand pain and swelling; by the third trimester the pain seriously restricted my mobility. I was referred to a hand specialist who examined my hands thoroughly, performed the Finkelstein test, and diagnosed me with bilateral – in both hands – De Quervain’s tenosynovitis and carpal tunnel. Um, double yay.

A hand therapist fitted me with immobilizer wrist and thumb braces. I called them The Gauntlets. I spent the last six weeks of the pregnancy wearing the braces at all times. This is a rest cure, but also serves as a kind of dog collar cone – if you can’t move your thumb and wrist, then the thumb and wrist won’t hurt. I prepared for daughter’s arrival by learning to manage with minimal hand use. As a writer, I mastered voice recognition software. A nutritionist helped me figure out which frozen microwave meals were healthiest. I reduced my driving, and acquired many accessibility devices like the special key holder I needed to unlock my front door. I picked the stroller that required the fewest hand movements to collapse it. I also saw a therapist to help me with anger management. I was livid that my body was betraying me when I needed it to be strong.

When my daughter was born, I spent the first week teaching myself how to pick her up and hold her. I became very good at maintaining a neutral hand position and moving my whole forearm instead of the wrist and thumb. I relied heavily on support pillows for nursing. The immobilizer braces gathered dust and instead I wore washable spica wrist braces that minimized thumb movement. I hated those braces so much. I just wanted to hold my daughter, in my hands. I took them off as often as I could stand it. I also removed them for diaper changes – I had no intention of trying to clean a diaper disaster off those things.

In terms of treatment, there are options to consider. In addition to the Gauntlets, I had physiotherapy, which taught me how to ice correctly. An option I considered, but decided against was corticosteroid injections. I know of other De Quervain’s patients who have had excellent results with the injections, but I was not comfortable with them while I was breastfeeding. I took anti-inflammatories, but for me they had limited effect. Extreme cases of De Quervain’s are candidates for surgery, but since the condition in pregnant and nursing mothers usually resolves, I never considered it.

This brings me to the great news: DE QUERVAIN’S USUALLY RESOLVES. In my case, I regained use of my hands when my daughter was around 14 months. This was about the time we started weaning, which anecdotally supports the hormone theory.

“But Laura, don’t you have two daughters? What happened in your next pregnancy?” EXACTLY THE SAME THING. Some friends and family were very surprised when I announced a second child was on the way. I had just gotten my hands back to normal. But the second time around I knew what might happen. I would like to say that made it easier, but wearing immobilizer braces when caring for a toddler is just, well, crazy. I will admit I hoped the first time was a fluke, but apparently my body reacts to pregnancy by setting my thumbs on fire. We all have something, right?

This is all behind me now, and I have had the use of my hands again for over three years. Looking back at the experience, here is what I would tell myself, back when I was struggling to cope with the challenges of motherhood without opposable thumbs.

1 – You can do this.

Women without any hands at all care for their children. You just need to figure out how to adapt each movement. Focus on one task at a time, and think of it as a problem to be solved. “I need to change a diaper/read this picture book/brush these little teeth. How can I do that without using my thumbs?” Practice makes perfect.

2- Re-organize your world.

I recommend getting an occupational therapist’s assistance in setting up your home and work spaces. De Quervain’s made me an enthusiastic fan of ergonomics. Something as simple as a nursing foot stool can make an incredible difference.

3 – Get support.

This means asking for help when you need it, from professionals, from your family and friends, from anyone in a position to pitch in. I am a pretty independent person, but I will forever be grateful to my in-laws for sending over a cleaner to do my floors.

4- Remember this condition is temporary, as is the time you get with your infant.

Try to focus on the cool little person you made. That’s what will matter.

Be well, everyone. Two thumbs up!