Easy on Those Thumbs: Techniques to Prevent 'Mommy Thumb'

February 14, 2011


Stretch marks, whacked-out hormones, an ugly scar from my emergency C-section. These were my post-natal worries. Losing the ability to use my left wrist wasn’t even on my radar.

But two months after Ellie was born, I noticed discomfort in the bony, bumpy spot where my thumb meets the wrist when I picked her up and put her down. Finding time in my new-mom day for a shower was a triumph. Forget getting to a doctor. So, I shrugged it off — until the pain became so severe I thought I’d drop my baby.

The tendon was inflamed and snapping out of place, an orthopedist told me last February. And that’s how I learned about Mommy Thumb — known by health professionals as De Quervain’s tendinitis and estimated to affect one-quarter to one-half of new moms.

“It’s essentially a strangulation of a group of tendons that run down your wrist into your hand,” says Scott Edwards, medical director of Georgetown University’s Center for Hand and Elbow Specialists. “These particular types of tendons are responsible for extending the thumb and the wrist, and we use them every day.”

Grannies, nannies, pop-pops and dads are at risk for the condition, but moms 30 years and older — I’m 32 — are the most likely candidates, he says. It starts with hormonal and fluid imbalances during pregnancy, although discomfort might not start until after delivery, when new repetitive motions such as picking up a baby exacerbate it.

At its best, the feeling is a slight tugging. At its worst, the tendon locks out of place, and I’ve lost feeling along my thumb. To verify that the pain is indeed Mommy Thumb, doctors use the Finkelstein test. Tuck your thumb into your fist and point your knuckles downward. If that hurts, you’ve got tendinitis.

Plenty of other moms feel my pain, especially 35-year-old Jennifer Rigg, who lives in College Park and has the condition in both hands. She keeps it under control using wrist splints, ice and modified movements. “I generally try and find techniques to adapt the way I do things so I’m not putting as much strain on those tendons,” Rigg says.

One way to prevent De Quervain’s is to modify how you pick up a baby. Instead of sliding your hands with your thumbs up under the child’s arms, scoop the child up under the tush, Edwards says. “That changes the forces across the wrist, and those particular tendons aren’t firing as vigorously,” he says.

Avoiding the condition can be tough, says orthopedic surgeon Steven Danaceau of the Arlington Musculoskeletal Center. “It’s truly hard to prevent, because it’s not bothering you beforehand,” Danaceau says. But once you feel discomfort, ice or heat packs; ibuprofen; a brace; and minimizing use can help. When those fail, an injection of cortisone usually does the trick, he says.

Noninvasive treatments focus on reducing swelling, but “surgery gives up on that,” Edwards says. “It unroofs the tunnel so the tendon can be as big as it wants as it slides through.” Surgery is rare — only about one in 20 of his patients need it — but 95 percent effective with little chance of recurrence.

By the time Edwards operates on me, almost a year to the day since my diagnosis, I will have tried ice packs; over-the-counter and prescription anti-inflammatories; and two steroid injections. But if Ellie will learn that a hug from Mommy doesn’t always come with a scratch from her brace, I’ll give her something I haven’t been able to offer: two thumbs-up.

Written by Stephanie Kanowitz
Photos by Marge Ely

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Stephanie Kanowitz · February 14, 2011