Brian Gralnick regularly plays tennis and hits the gym. But he has a chronic problem with his left rotator cuff and has to be careful about overburdening that shoulder. So when his daughter, Liv, was born last March and he became the primary caregiver once his wife returned to work at a Philadelphia hospital, he favored his right side when holding her.
“I held Liv in my right arm and right hand,” recalled Gralnick, 40, from Elkins Park. “She was sitting on my wrist and my forearm was at a 90-degree angle at my elbow. I was also running with the stroller with my right arm to preserve the left.”
Then, while stretching one day at the gym, he had excruciating pain in his right forearm. That night, he couldn’t break a piece off a chocolate bar without major pain.
“I took a pause on the gym and other activities that would strain it and eventually saw an orthopedist, who said it was an overuse injury related to tendinitis around holding my baby,” he recalled.
De Quervain’s tenosynovitis, the type he was diagnosed with, is more commonly known as “mommy’s thumb” or “mommy’s wrist” because it most often affects new mothers. Yet, “parent’s thumb” or “caregiver’s thumb” is a more apt description, as anyone caring for a newborn is susceptible. The fact that women are eight to 10 times more likely to suffer than men may be a reflection of who is caring for newborns, as that part of the anatomy is similar in both sexes, said Pedro Beredjiklian, chief of the division of hand surgery at the Rothman Orthopaedic Institute.
“De Quervain’s tenosynovitis is a tendinitis of the wrist right at the base of the thumb,” said David Steinberg, professor of orthopaedic surgery at the University of Pennsylvania. That’s the spot often affected while constantly picking up, holding, and feeding babies, any of which can involve awkward hand positions. As the baby grows and gets heavier, more pressure is placed on the tendons.
“The tendons become irritated, causing pain and ultimately limiting the amount they can move the wrist because of all the swelling,” Steinberg said. Pain that radiates into the thumb or forearm is what sufferers tend to notice first. “Because of the pain, patients may have weakness of the hand, problems gripping or opening bottles or jars. That’s the body’s protection mechanism to avoid feeling that pain.”
Not all new parents or caregivers get this, said Beredjiklian. “But we don’t know the variables or the risk factors as to why some do and others don’t,” he said. “Our thumbs account for about 50% of hand function.”
The condition can also affect pregnant women, especially in the third trimester because they retain fluid. That can make the hand and wrist area feel tighter and even become inflamed. Fortunately, the problem usually subsides once the baby is delivered, Beredjiklian said.
Unfortunately, that wasn’t the case for Suzy Danielyan, who suffered hand and wrist pain throughout her pregnancy. The pain was often excruciating, radiating up her arms. She tried wearing a hand brace but didn’t get much relief.
“My ob/gyn told me it could be carpal tunnel, which is very common with having edema [swelling] in my hands and that it should go away after I deliver the baby,” recalled Danielyan, 31, from Ardmore.
“It ended up getting worse after delivery, to the point where it was affecting picking her up, changing her, and things as simple as holding a pen,” said Danielyan, who then saw an orthopedist and discovered she had De Quervain’s tenosynovitis.
After her daughter, Angela, was born in July, Danielyan got a cortisone shot, which is effective about 60% of the time to minimize the symptoms, Steinberg said. Per her doctor’s recommendation, Danielyan pumped and dumped her breast milk for two days after her injection, giving Angela formula during that time.
The cortisone shot helped, and she has also altered how she picks up her daughter. Instead of lifting her under her armpits, which separates the thumb from her other fingers, she now places a flat hand behind her baby’s head.
While Danielyan acknowledges that wearing a brace could give her even more relief, “I need to have full range of my hands to care for a newborn,” she said. “But I definitely see an improvement.”
Before using such aggressive therapies as cortisone shots, initial treatments include RICE (rest, ice, compression, and elevation), Beredjiklian said. Wearing a splint or wrist brace can be very helpful, though he recognizes how difficult that is for any caregiver. A thumb spica, a type of splint that will protect the wrist and thumb to totally immobilize the affected ligaments, worn at night, can allow the tendon to rest.
Sometimes anti-inflammatory medications can help, but if a woman is breastfeeding, she needs to ask her pediatrician whether the medication is safe for her baby. When these treatments aren’t effective, surgery to alleviate pressure and inflammation around the tendon is about 95% successful.
Though holding a baby is the leading cause of De Quervain’s tenosynovitis, it can be caused by any repetitive side-to-side wrist motion and is also more likely to occur in someone who has broken their wrist, Steinberg said. The condition can be aggravated by continual texting, which also affects the tendons around the thumb and wrist.
That was the case for Gralnick, who realized his cell phone use was a contributing factor. Between cutting back on the phone use, physical therapy, and being more mindful of how he’s holding Liv, he’s improving.
While there aren’t ways to prevent getting this condition in the first place, “catching it early can be helpful in avoiding aggressive treatment,” Beredjiklian said.
“Obviously, you try to be as prepared as possible when having a baby, in terms of health care, finances, and child care,” Gralnick said. “But tendinitis and overuse of your forearm muscles isn’t something I was prepared for.”