I just found out today, many years after I delivered my baby, that the arthritis-like pain I had in my thumb, wrist and forearm, has a name. It’s called Mommy’s Wrist ─ a nickname to suggest that the pain you’re feeling is associated with being a mother and that it’s common.
I remember quite clearly that when I had it, the pain was a sudden onset. Two days after coming back from the hospital with my baby, I woke up with a numbing, awful ache that ran from the base of my thumb at the side and wrist right up to the forearm. Every movement I made ─ such as pick up my baby, breastfeed, change his diapers ─ was excruciating. In fact, the pain was so bad I couldn’t carry my baby or flex my wrist or grip anything with my fingers and thumb at all.
Luckily, it only affected one hand ─ my right hand ─ but that was sufficient to immobilize that hand completely. I did wonder if it might have been due to me twisting my wrist in an awkward way to hold up my book in bed as I read. I was always reading before going to sleep throughout my pregnancy, and towards the last few weeks, I was devouring my pregnancy books even more voraciously. Those books were thick and heavy. Sleeping during those final weeks was also very uncomfortable ─ my humongous belly was always contorting my spine no matter how I slept, and I thought I might have slept on my hand or twisted it while trying to find a comfortable position.
Funnily enough, the hand did not hurt during the pregnancy itself, no matter how I slept. It only happened after I gave birth so I was quite perplexed. It got so bad, I could not grip anything, especially a pen, so I had difficulty writing or signing my name on any forms. I remember clearly, I even tried to write with my left hand to compensate.
In hindsight, I might have had the beginnings of Mommy’s Wrist from somewhere during mid-pregnancy onwards, only I didn’t notice or did not put too much thought into why my hands were numb and could not feel anything. I was forever dropping things. I could not feel what I was holding but I put that down to water retention and swelling which was normal. I only noticed when the pain became acute after delivery.
Throughout the episode though, I did not seek treatment, so I was never diagnosed and after a few tortuous weeks of struggling with my disability, the pain miraculously faded away and my hand could once again return to its full flexibility.
de Quervain’s Tendonitis
[dropcap letter=”M”]ums, if you have similar pain in your hand or hands, it could be that you have Mommy’s Wrist or de Quervain’s Tendonitis.
Named after Fritz de Quervain, the Swiss surgeon who first described and treated it back in 1895, the condition is caused by an inflammation of the tendons of the thumb located at the thumb side of the wrist, due to repetitive movement.
In fact, de Quervain’s Tendonitis was once called “Washer Woman’s Syndrome” because of the repetitive hand movements and awkward twists to the wrist women used to wring out wet clothes. Of course, these days, we use the washing machine and no longer wring out wet and heavy laundry. Still, the repetitive movements of using the wrist, thumb and hand to carry a baby, or lift a growing child to his seat, or carry heavy groceries can cause the tendons in the wrist to become inflamed from overuse.
Causes of Pain in the Wrist
You may have guessed by now that tendonitis refers to the tendons. Tendons are rope-like structures that attach muscle to bone. Tendons are covered by a slippery thin soft-tissue layer, called synovium. This layer allows the tendons to slide easily through a fibrous tunnel called a tunnel sheath.
The two main tendons that pass through to the thumb from the wrist go through this tunnel (like a series of pulleys) and connect to our forearm. These muscles allow our thumbs to pinch, grasp, or squeeze objects or wave from side to side. Therefore any swelling of these tendons or thickening of the sheath results in increased friction and pain with certain thumb and wrist movements.
Other symptoms include:
- Swelling near the base of your thumb and wrist area. Sometimes there is a fluid-filled cyst here.
- Numbness along the back of your thumb and index finger.
- A “catching” or “snapping” feeling when you move your thumb.
- A squeaking sound as the tendons move within the swollen sheaths.
- Apart from repetitive hand and wrist motions, hormonal changes during pregnancy can also cause it. As our PORTAL MyHEALTH says, de Quervain’s syndrome is associated with pregnancy.
Thank goodness it is a temporary condition. According to Mayo Clinic if your de Quervain’s tendonitis started during pregnancy, the pain is likely to end around the end of either pregnancy or breast-feeding. If it started during the post-natal period then it is likely to be over in a few weeks, like in my case.
De Quervain’s tendonitis is also known as de Quervain’s tendinosis or de Quervain’s tenosynovitis. But they all mean the same thing: Pain in the wrist and thumb caused by sore tendons.
Carpal Tunnel Syndrome (CTS)
[dropcap letter=”S”]ince my hand pain was undiagnosed, I cannot be sure if I had de Quervain’s tendonitis or Carpal Tunnel Syndrome (CTS), or both. It is possible to develop both conditions at the same time during pregnancy, or one or the other, as both involve pain in the wrist and fingers caused by swelling and inflammation.
CTS is very common in pregnancy, maybe even more so than de Quervain’s tendonitis. According to a 2015 study, CTS is a frequent complication of pregnancy, with a prevalence reported to be as high as 62% in pregnant women. The most typical symptoms are numbness and tingling in the thumb, index finger, middle finger, and radial half of the ring finger. It can affect one or both hands and may take longer to resolve than de Quervain’s tendonitis as CTS can continue, or develop in the days after the birth of your baby.
CTS usually happens in the second trimester or third trimester. One study found 40% of participants reporting the onset of symptoms after 30 weeks of pregnancy. If you have CTS in one pregnancy, you are likely to have it in later pregnancies.
Dr Nachi Explains Carpal Tunnel Syndrome
Dr Nachiayappan Annamalai, Obstetrician & Gynaecologist at Mawar Medical Centre, Seremban, says: “Carpal Tunnel Syndrome is a nerve compression issue. The median nerve in the wrist is being compressed due to excessive of fluid during the pregnant condition. That fluid build-up can cause compression to the median nerve and you start feeling tingling sensations three fingers of your hand. You have to do some medication or pain relief such as massaging your hand or rest it or soak it in water to relieve the numbness. However, it is not dangerous or anything. Once you deliver the baby, your pregnancy fluid will reduce, then the discomfort should resolve on its own.
“In a severe situation where the pain and tingling sensation can disturb your quality of life, then a small surgery may be required. They nick the median band and release the pressure on the median nerve. This should be done by the Orthopaedic department. But it is very, very rare to do this surgery.”
Median Nerve Compression
The carpal tunnel is located in the wrist space and this space encases important structures like the median nerve, flexor tendons of the hand, ulnar nerve, and so on. The median nerve in this tunnel easily gets compressed whenever there is compression of this space. Since fluid retention is common in the second trimester of pregnancy onwards, CTS starts showing itself from mid-pregnancy onwards.
CTS Symptoms are
- Pain, numbness and tingling in whole hand rising up to the arm.
- Worst pain is in the thumb, index and middle fingers when the median is squeezed or compressed.
- Inability to make a fist, hold an object in the hand, dropping things and other clumsiness of the hand.
- Difficulty doing daily chores, like brushing teeth, buttoning and unbuttoning clothes, holding a pen, sewing, typing, doing artwork and craft and other fine motor work.
- Heightened susceptibility to burns and accidents (like cutting oneself while cutting vegetables) due to reduced sensation in hand and clumsiness.
Which Pregnant Women are More Prone to CTS
Not all pregnant women will get CTS but some will. Those who are prone include:
1.Those who are Overweight or Obese before and during pregnancy
A study published in NCBI found that mothers with CTS had high rates of overweight, obesity, and excessive gestational weight gain.
2. Those who have pregnancy-related Diabetes and/or Hypertension
High blood pressure and high blood sugar levels are factors that predispose CTS.
3. Those who have Hypothyroidism and Autoimmune Diseases
It’s a vicious cycle. Reduced metabolism in hypothyroidism can lead to excessive weight gain and fluid retention. Autoimmune Diseases cause widespread inflammation including the carpal tunnel of the hand. Autoimmune diseases include rheumatoid arthritis, systemic lupus erythematosus, and thyroiditis which can lead back hypothyroidism, says this medical research.
If you have hand pain, especially in the wrist, during and after your pregnancy, do check with your doctor. And do read the self help guide in the next article on Relief for Hand Pain during Pregnancy.
For more stories on pregnancy and related issues, check back on Motherhood.com.my.