Why does my wrist hurt when I pick up my baby?

baby 1 by Lauren Stevenson

You have successfully survived 9 months of pregnancy, and baby has finally arrived. Now suddenly you are experiencing pain around your thumb and wrist every time you try and breast feed, bath or lift up your little bundle of joy…. What next?!

This is a commonly told story at Wellhand. Many women and occasionally very dedicated dads develop a condition known as de Quervain’s Tenosynovitis. This is an irritation of the tendons on the side of the wrist which are responsible for the outwards movement of your thumb. These two specific tendons (extensor pollicus brevis and abductor pollicus longus) run through a narrow tunnel on the thumb side of your wrist.

The irritation of these tendons often occurs when you start to do repetitive side to side movements of your wrist and thumb, e.g. trying to lift a baby in and out of the car seat, or holding babies head while breastfeeding. These are all actions that your hand and wrist are not used to.  Like wearing a pair of shoes that fit poorly and going for a 10km walk, your tendons get increasingly more irritated with the friction in their tunnel.  For this reason, this condition tends to get worse over time instead of better.

The first step to recovery is identifying if this is in fact the reason for your pain. Have a chat with your GP or hand therapist if your symptoms fail to settle.  Treatment involves the following:

  1. Splinting your wrist and thumb – to limit the friction of the tendon
  2. Pain management – Therapy, e.g. massage, heat/cold, and tendon gliding exercises can be of benefit. Medication prescribed by your GP can also be helpful
  3. Discussing and analysing the way you use your hands when doing these new repetitive tasks and coming up with alternatives to prevent repeated injuries
  4. In cases where the above fails to help, a cortico-steroid injection into the area of pain is an option
  5. In complex cases, where all else fails, there is an operation which releases the tendons from their tight tunnel.

So no need to suffer in silence, there are things that can be done to resolve this added ache and pain.

When can I drive again?…

mr bean

Lots of patients ask us when they can drive following a hand injury. If you have a physical disability (long term), you can often get modifications made to your vehicle which will enable you to drive. Even something simple like a spinner on the steering wheel can make a difference. We can put you in touch with someone who specialises in assessment and vehicle modifications.

For a temporary disability, such as having your arm in a cast or a splint, there is only a small amount of research in this area, however you need to consider the following things. The NZTA say ”… you need to decide how safe you and other road users will be. Plaster casts may be uncomfortable and can make it difficult to control a vehicle. You must get guidance from your doctor concerning how your cast will affect your ability to operate all the vehicle controls”.

In addition to this, consider your insurance policy and if you are covered. Insurance companies differ in their policies, so it pays to check yours. In particular, if your doctor has specified you cannot drive, it is doubtful your insurance company will cover you.

A few studies have looked at uninjured people driving with a cast or splint on.  The observed effects over 4 out of 5 studies showed increased time to complete the assessment, poorer response to hazards, and failing or loss of points on the on-road driving test. Casts that immobilised the elbow and thumb showed a greater impairment.¹

Another recent study looked at driving in a sling in a driving simulator. Most people could manage routine activities such as turning corners, however the people in the sling ran into problems dealing with an emergency.²

A thing to note with all of these studies is that the subjects were NOT INJURED, they were only immobilised.  It seems logical to conclude that an injury or operation would cause more issues due to pain and restriction.

In summary, don’t drive if you feel you could be putting yourself or others at risk, and remember it is the emergency or hazardous situation which may be the issue. Seek advice from your doctor if you are unsure.

 

References:

  • Stinton et al: When can I drive? Return to driving following a wrist fracture: A critical review. Hand Therapy 2015, Vol20(3), 95-101.
  • Hasan S et al: The effect of shoulder immobilisation on driving performance. J Shoulder Elbow surgery. 2015 Feb: 24(2); 273-9

I keep waking up at night with pins and needles in my hand…

Carpal tunnel syndrome (CTS) is caused by the compression of the median nerve at the wrist as it passes through the carpal tunnel.  The tunnel itself is a tight space bounded by bones and a tight ligament.  The nerve shares the tunnel with 9 other tendons!

Figure 1. Median nerve in red, transverse carpal ligament forming the carpal tunnel in blue
Figure 1. Median nerve in red, transverse carpal ligament forming the carpal tunnel in blue

Problems may start to occur when the wrist is swollen or as a result of general wear and tear.  The main symptoms are pins and needles, or numbness, which are present in the thumb and fingers, and generally wake you up at night. These symptoms may further progress with symptoms occurring during the day, and you may also start to experience pain and weakness of the hand which results in you dropping things. Bear in mind numbness or pins and needles in the hand can be from other causes such as a pinched nerve in the neck, or potentially from a more serious condition such as multiple sclerosis.

There are many risk factors for CTS and some of these include working for prolonged periods with the wrist in abnormal postures (such as extreme bent or extended positions), menopause or pregnancy. Women are more likely to develop this condition.

Tests

Clinical tests – Our Hand Therapists can carry out various clinical tests for CTS.

Electrical diagnostic testing – these include nerve conduction studies which can only be carried out by Neurology Specialists. You need your GP or surgeon to refer you for these.

Ideally a combination of clinical and electrical tests are carried out to confirm a diagnosis of CTS

Treatment

Splinting:  Evidence shows that splinting can resolve over 50% of cases of CTS. Splints are most commonly prescribed for those with night symptoms, but they can also be used during the day for aggravating activities. We can provide you with a correctly fitting splint designed for this purpose.

Figure 2. Example of a night splint
Figure 2. Example of a night splint

Exercises: Exercises target the “glide” of the median nerve within the carpal tunnel. There is emerging evidence to show that this is helpful in the management of CTS. These exercises need to be performed with care and we can guide you as how to carry these out effectively.

C Trac: This is a small hand-based device which aims to stretch the transverse carpal ligament. It is generally used three times daily, for a period of four weeks. Based on a small study, there were good results for using this device for the management of CTS. We can loan this device out to you for a period of time.

Figure 3.  The Ctrac
Figure 3. The Ctrac

Activity modification: This is particularly vital for those with aggravations from particular postures during the day. We can advise you on what positions are likely to aggravate your symptoms, and we can provide you with tips on how to modify your activities.

Referral to a specialist:  We can refer you to a hand surgeon  for their opinion on management, and possible consideration for surgery, if the above mentioned conservative measures fail to improve your symptoms.  Severe  weakness and wasting of the thumb muscles require prompt referral to a surgeon.

Post-Operative Therapy

Following carpal tunnel release, a hand therapist can play a role in assisting you manage any ongoing symptoms. We can provide you with nerve exercises if these are required, and we can also provide treatment for hypersensitive or thickened scars or “pillar pain”.