What is Mommy’s Wrist?
Mommy’s wrist is a term for DeQuervain’s tendonitis, a type of painful tendonitis common in mothers of young children. This causes pain on the thumb side of the wrist, worse with movement of the thumb. Opening jars, turning door knobs, and caring for the young child can be difficult.
Symptoms arise when there is irritation of the tendons of the thumb within the surrounding sheath at the wrist. Instead of gliding smoothly through the sheath, the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons can be swollen, irritated and painful. Patients report pain in the thumb-side of the wrist. Certain movements of the thumb and wrist can be excruciating. Patients may feel a tender cyst or bump and notice swelling in the wrist. Lifting objects, gripping, or pinching with the thumb often increases symptoms. Occasionally popping of the tendons is noticed by the patient.
What causes the tendonitis?
The cause of DeQuervain’s tendonitis is usually unknown, but symptoms can be brought on by starting a new, repetitive activity. The condition is common in females, especially pregnant women and mothers of young children. It has been called “mommy’s thumb” or “mommy’s wrist” because of this association.
DeQuervain’s can be diagnosed by history and physical exam in the office. An x-ray can sometimes be helpful to rule-out other conditions, such as arthritis or wrist fracture.
Finkelstein’s test can help confirm the diagnosis. During this exam test, the patient places their thumb into their palm and wraps/clasps their fingers around the thumb. The patient then moves their wrist in the direction towards their small finger, reproducing their pain (take care, this can be very painful to do!).
What are the treatment options for Mommy’s Wrist?
Fortunately, most people improve with time and never need surgery for DeQuervain’s. Therefore, non-operative treatment is tried first for most patients. Treatment is aimed at reducing pain and improving function. Wearing a splint which supports and immobilizes the thumb and wrist (“thumb spica brace”) can help reduce symptoms. Off-the-shelf and custom-made braces are available. Resting the hand by avoiding repetitive thumb motion and forceful gripping may reduce the irritation of the tendons. Anti-inflammatory medications such as Ibuprofen, Naproxen, and Tylenol can reduce pain. Hand therapists can teach stretching exercises and reduce pain with modalities such as iontophoresis treatment. Adjusting the way you use your hand can help as well.
Many people can be cured with a cortisone shot or two. Corticosteroid injections are very effective in reducing or eliminating symptoms in approximately 80% of patients. The risks of corticosteroid injection (also called a “cortisone shot”) are pain, infection, skin color change, and rarely atrophy of the skin at the injection site. Diabetics should be aware that blood sugar control can be elevated for a few days afterwards. Also multiple injections should be avoided as they can cause weakening of the soft tissues over time.
If these measures fail to improve the symptoms, surgery may be offered after attempting non-operative treatment. DeQuervain’s release surgery is performed to improve the gliding of the tendons with the goal of reducing pain. During this procedure, the tight sheath (extensor retinaculum) is opened through a small incision on the thumb-side of the wrist.