Tidbits of information about:
Mommy’s wrist, carpal tunnel and nerve damage in the upper extremities
Carpal Tunnel Syndrome:
Symptoms
Numbness and tingling in the fingertips of the first three digits, which is more likely to occur at night. Hand shaking at night can cause nighttime wakening.
Risk Factors
Pregnancy, multiple births and age over 30.
Hormonal changes during pregnancy can cause fluid retention and swelling that may affect the upper extremities. Hand symptoms are common affecting up to 60% of pregnant women, but older estimates are lower. Repetitive hand posture and motion: ex: diaper changing, lifting and carrying newborn/toddler.
Common Beliefs
False: Carpal tunnel syndrome only occurs in the third trimester.
True: Symptoms can occur at any stage of pregnancy including the postpartum period.
False: Symptoms will resolve after delivery.
True: Symptoms may improve but do not resolve completely after delivery, rather symptoms may continue throughout the postpartum period. In fact symptoms that begin earlier in pregnancy are more likely to continue after delivery.
Symptoms
A form of tendinitis that affects the area where the wrist and the base of the thumb meet.
Difficulties with activities that involve grasping, twisting and lifting requiring use of hands, wrists and thumbs.
Positive Finkelstein’s Test: This is a test that is used to diagnose Mommy’s wrist. Create a fist placing your thumb across the palm, wrapping your fingers around your thumb. With the pinky side of the fist facing the floor, slowly bend your wrist towards the floor. If you experience discomfort and pain radiating up the inside of the arm from the thumb when doing this movement then this is indicative of Mommy’s wrist. (Allbrook, 2019)
De Quervain’s tenosynovitis a.k.a. Mommy’s thumb/wrist:
Risk Factors
It is an overuse injury: Like trigger finger and carpal tunnel syndrome, de Quervain’s disease is a musculoskeletal disorder caused by repetitive hand posture and motion. (Shen et.al. 2015)
These are the risk factors for the general population:
Women are at greater risk than men: In the general population studies have shown that Mommy’s Thumb most commonly occurs in women at a rate more than ten times higher than men. (Ramchandani et.al. 2022)
Age 30-50 years old: There is a high prevalence of the disease reported in these individuals. (Hadianfard et.al. 2014)
Anatomical differences between women and men: Women have greater mobility in this joint leading to additional irritation of the tendons and swelling.
Higher expression of the hormone estrogen in women: Specifically estrogen receptors which have a high affinity for estradiol, a major female sex hormone that regulates menstrual and reproductive cycles. Men have low levels compared to females. Expression of estradiol was found to be higher in patients with De Quervain’s disease, the greater the severity of the disease the more estradiol was found. (Shen et.al. 2015)
Women are already at a higher risk of developing this injury in the general population, pregnancy and postpartum puts women at an even greater risk. Here are the reasons why:
Women in the later stages of pregnancy and in the early postpartum period are most commonly affected by Mommy’s thumb/wrist.
In the postpartum period the injury is caused by overuse in the hands and wrists from constantly lifting, changing, breastfeeding, carrying and holding a baby. Mechanical overuse in combination with hormonal changes in estrogen and progesterone levels can put great stress (swelling/fluid retention/ligament stretching) on your musculoskeletal system during your recovery. As the baby grows and becomes heavier, more pressure is placed on the tendons causing irritation, pain and swelling eventually limiting the amount one can move the wrist. (Hadianfard et.al. 2014)
Changes in estrogen and progesterone levels also occur during pregnancy, which can cause mommy’s wrist. (Shen et.al. 2015)
Women who have a diagnosis of carpal tunnel prior to pregnancy are at greater risk of developing mommy’s wrist during pregnancy and postpartum. You should tell your doctor in order to start preventative care (such as occupational therapy) early in pregnancy. (Mandiroglu et.al. 2021)
Takeaways
Anyone who is caring for an infant is at an increased risk of developing de Quervain’s tenosynovitis because of the repetitive lifting and carrying forcing the wrist into ulnar deviation, pictured here:
Ulnar deviation
Caregivers for infants/children should limit lifting and carrying children as much as possible and find alternative/ergonomic ways to perform daily tasks. (Goel et.al. 2015)
This is why proper ergonomic lifting is so important!