Hand surgeon John M. Erickson, MD explains the phenomenon called “mommy’s wrist.”
“Mommy’s wrist” or “mommy’s thumb” is a condition that is officially called de Quervain’s tenosynovitis (or tendonitis). This is a type of tendonitis in the wrist whose nickname comes from the fact that the condition is common in caregivers of young children. The tendonitis causes pain on the thumb side of the wrist and is worse with movement of the thumb. Activities such as opening jars, turning door knobs, and lifting children can be difficult.
Symptoms arise from de Quervain’s tendonitis when there is irritation of the tendons that extend the thumb in their 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. Certain movements of the thumb and wrist can be excruciating. People may feel a tender cyst or bump and notice swelling in this part of the wrist near the base of the thumb. Lifting objects, gripping, or pinching with the thumb often increases symptoms. Occasionally, a popping sensation is a problem.
What causes the tendonitis?
The cause of de Quervain’s tendonitis is usually unknown, but symptoms can be brought on by starting a new activity. The condition is common in women, especially pregnant women and mothers of young children.
This type of tendonitis can be diagnosed by history and physical examination in the office. An x-ray can sometimes be helpful to rule-out other conditions, such as arthritis or a 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 de Quervain’s tendonitis. Therefore, non-surgical treatment is tried first for most people. Treatment is aimed at reducing pain and improving function. Options can include:
- 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. Topical medications can be used as well.
- 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.
- Corticosteroid injections are very effective in reducing or eliminating symptoms in many patients.
If these measures fail to improve the symptoms, surgery may be offered and is typically curative.
Dr. John M. Erickson is a hand and upper extremity specialist at the Raleigh Hand Center. He trained in orthopedic surgery at the University of Michigan and completed a hand surgery fellowship at Vanderbilt University. He19 is an active member of the American Society for Surgery of the Hand (ASSH).