De Quervain's Disease: The Wrist Pain Common Among Mothers

Sometimes when lifting your baby or performing common hand movements, you may experience pain at the base of your thumb and wrist. The pain, triggered by gripping movements between thumb and index finger or repeated wrist flexion, often accompanied by swelling, may be caused by De Quervain's Disease, also known as mother's wrist.

We discuss this with Dr. Laura Loda, hand surgeon at Image Regenerative Clinic.

What is De Quervain's Disease?

De Quervain's Disease is inflammation of the sheaths covering two thumb tendons called the abductor pollicis longus and extensor pollicis brevis. It's sometimes called mother's disease because new mothers often extend their thumbs maximally when lifting their babies, causing tension in these tendons.

It is primarily a degenerative condition that initially manifests as painful friction during tendon movement and increased synovial inflammatory fluid (exudative phase). If untreated shortly after symptom onset, the condition becomes chronic, synovial fluid production stops, and the tendon sheath thickens, causing obstruction of tendon movement through the canal (nodular phase).

What are the symptoms of De Quervain's Disease?

Common signs and symptoms include gradual onset of swelling and pain in the wrist and near the thumb base. The pain may radiate along the forearm and can cause difficulty in performing daily activities, such as grasping objects with an extended thumb and fully flexed or extended wrist. Advanced cases may present with tingling along the dorsal aspect of the thumb.

What causes De Quervain's Disease?

De Quervain's Disease can be caused by various factors, though the most evident connection is repetitive stress on the abductor pollicis longus and extensor pollicis brevis tendons and wrist. These movements are common in daily activities such as using keyboards, mice, musical instruments, and infant care. Other risk factors include microtrauma, anatomical variations, hormonal changes during pregnancy, rheumatoid arthritis, and genetic predisposition.

How is De Quervain's Disease diagnosed?

Diagnosis is primarily clinical, based on specialist evaluation during examination and specific tests where the physician grasps the patient's thumb and pulls it toward the little finger, triggering pain if De Quervain's Disease is present. In some cases, ultrasound may be necessary to reveal alterations in affected tendons and their relationship with canal walls.

What is the treatment for De Quervain's Disease?

Initial stages warrant conservative treatment. This includes corticosteroid injections, anti-inflammatory and analgesic medications, ultrasound, tecar therapy, shock waves, ozone therapy, braces, kinesio taping, and avoiding repetitive manual work. Regenerative therapy with Lipogems tissue is also indicated in early stages, utilizing the regenerative properties of mesenchymal cells in adipose tissue to reduce inflammation and promote tissue healing.

In chronic stages and when conservative treatments fail to provide lasting results, surgical release of De Quervain's canal becomes necessary. The procedure is performed under local anesthesia in an outpatient setting, involving a skin incision on the external wrist margin centered on the first extensor compartment, and retinaculum release allowing tendon movement without pain or friction.

Post-surgery hand movement is possible without protective braces. Care should be taken to keep the wound clean and avoid excessive loads for approximately 10 days. Physiotherapy is recommended to prevent scar adhesions and promote faster functional recovery.