The time after pregnancy can be difficult for new mothers. The rollercoaster of hormone fluctuations do not help and have been linked to several problems post partum. Progesterone is normally high during pregnancy, but can sometimes fall too low after delivery. Progesterone is essential for maintaining bones. This, along with other hormonal changes can lead to significant problems following birth, particularly ‘baby wrist.’
Why It Happens
Many mothers complain of wrist pain after pregnancy. This can range from a mild irritation when picking up your baby, to severe pain that leaves you unable to grip with your thumb. As with many conditions surrounding pregnancy, some of the blame is down to hormones. During pregnancy your body undergoes various hormonal changes. These affect many parts of your body and how it works, including your ligaments and tendons. One particular culprit is a hormone called relaxin. Unsurprisingly one of the roles relaxin has in the pregnant body is the ‘relaxation’ of ligaments. Due to the increasing size of the foetus and the necessity of delivery, it is thought it relaxes the ligaments around the pelvis. This allows greater space and an increase in the size of the birth canal between the pelvic bones. Unfortunately relaxin can have a systemic effect. In other words, it can affect many ligaments and tendons in the body, including those around the wrist and thumb.
New mothers are particularly prone to exacerbation of any hormone-induced tendon weakness. Picking up and holding babies quickly becomes a common routine. This places a new stress on the tendons of the thumb that they were not used to before. Babies are still reasonably heavy and the tendons and supporting muscles of the wrist and thumb have not had time to become conditioned. Baby wrist can be exacerbated even further by certain ways you hold your baby. Feeding is a common complaint due to the unnatural position your wrist can be put it when holding your baby, especially when using a bottle. Couple these new strains with the lax ligaments and tendons, and the result is pain and inflammation. This pain is sometimes called ‘baby wrist’ and is due to a condition called deQuervain’s tenosynovitis. Tendons attach muscle to bone. DeQuervain’s affects two tendons of the thumb. You can find these tendons on yourself. Do the ‘thumbs up’ sign and then feel around the base of the back of the thumb where it meets the wrist. There should be two tendons that feel about a fingers width apart.
An easy way to understand what tendonitis is like, think of them like a brake cable on a bicycle. The cable is the tendon, and the surrounding black plastic sheath is called a synovium. The synovium contains a lubricating fluid, much like the oil in a brake cable. This allows the tendon to move within the sheath without catching. In tendosynovitis, the synovium becomes inflamed, hampering this lubricated movement. Unsurprisingly this causes pain because the tendon can no longer move smoothly. The new repetitive use and strain from picking up and holding babies on a tendon weakened by hormones tendon inflamed and you in pain. There is an easy test you can do at home to check if your wrist pain might be deQuervain’s tenosynovitis. Bend your thumb into your palm and then close your fingers around it. Your hand should now be in a fist with your thumb being gripped within it. Now bend your wrist away from your thumb (cock your wrist downwards, stretching the thumb side of your wrist). If you feel pain around your thumb or in the wrist near the thumb then you might have deQuervain’s.
What You Can Do
It is important to treat deQuervain’s quickly and not just ignore it. For some it will go away on its own as the requirements of holding a baby diminish due to their growing development and independence. However, for others it can lead to a chronic inflammation that will cause suffering for years to come. The key to treating Baby wrist is recognising it early and prompt treatment.
Treatment will include reducing the activities that aggravate the condition, simple stretches, physiotherapy and splinting. A splint is a strapping that holds the thumb still, reducing thumb movement and thus reduces inflammation, allowing the tendons to heal. Make sure to get one that is specially designed to fit your hand and wrist (thermoplastic). Avoid off-the-shelf splints as these may exacerbate the condition. The splint may need to be worn during the day time as well as at night. This is because the activity and movements that are causing the problem occur during the day.
For some people anti-inflammatory injections or surgery may be required if the splint is not enough. The important message is to ensure good progesterone levels for strong healthy bones and to see a specialist if necessary so that the problem does not snowball into a chronic pain that can be much harder to treat.
Mr Tony Kochhar completed his training at the Royal National Orthopaedic Hospital in London and has completed specialist fellowships at worldwide centres of excellence in New York and the Alps Surgery Institute in Annecy, France. He is the most notable in his field and has the highest success rates of recoveries.
His treatments include physiotherapy, shoulder surgery, elbow surgery, sports injuries, Xiapex treatments for Dupuytren’s Contracture, wrist and hand surgery, injection therapy and osteopathy. He can be contacted via his website at http://www.shoulderdoctor.co.uk/