“Mother’s Thumb” is the common name for De Quervain’s tenosynovitis, a painful condition involving the swelling and irritation of specific tendons on the thumb side of the wrist. It frequently affects new parents and caregivers due to the repetitive, often awkward, motions involved in lifting and holding an infant. The medical term refers to the inflammation of the tendon and its surrounding protective sheath, which leads to friction and restricted movement. This condition can interfere with simple daily tasks and make infant care difficult.
The Anatomy and Mechanics Behind Mother’s Thumb
The wrist pain originates from an issue within the first dorsal compartment, a narrow tunnel on the thumb side of the wrist. Two specific tendons pass through this compartment: the Abductor Pollicis Longus (APL) and the Extensor Pollicis Brevis (EPB). These tendons control thumb movement, allowing it to move away from the palm and straighten its joints.
The tendons are normally protected by a slippery sheath of tissue called synovium, which allows for smooth gliding. Frequent, strenuous, or repetitive motions, such as lifting a baby with the thumb pointed upward, generate friction. This repeated irritation causes the tendons and their sheath to swell and thicken (tenosynovitis).
The swelling within this confined space restricts the tendons’ ability to slide freely, leading to increased friction, pain, and catching sensations. Hormonal changes during pregnancy and the postpartum period, which cause fluid retention, may also contribute to the swelling and constriction of the tendon sheath. This makes new mothers particularly susceptible to the condition.
Recognizing the Symptoms and Confirming the Diagnosis
The primary symptom is pain and tenderness felt directly over the thumb side of the wrist, near the radial styloid. This discomfort can develop suddenly or gradually, often radiating up into the forearm or down into the thumb. Pain is aggravated by movements involving gripping, pinching, or forcefully twisting the wrist.
Other signs include visible swelling and difficulty or weakness when grasping objects. Some individuals report a catching, snapping, or popping sensation when moving their thumb. These symptoms signal the tendons are struggling to move through the narrowed, inflamed tunnel.
A physical examination confirms the diagnosis, often using the Finkelstein test. To perform this test, the patient makes a fist with the thumb tucked inside the other fingers. The examiner then gently bends the wrist toward the little finger side (ulnar deviation). If this maneuver sharply increases the pain along the thumb side of the wrist, the test is positive for De Quervain’s tenosynovitis.
Treatment and Recovery Options
The goal of treatment is to reduce tendon inflammation and irritation, typically starting with conservative, non-surgical methods. Rest is foundational, requiring avoidance of specific repetitive activities that cause pain, such as modifying how a baby is lifted to keep the wrist straight. Immobilization is achieved by wearing a splint, often a thumb spica splint, which keeps the wrist and thumb stable to allow the tendons to rest.
Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can be taken orally or applied topically to reduce pain and swelling. Applying ice several times a day can also help manage localized inflammation.
If symptoms do not improve with these initial approaches, a physician may recommend a corticosteroid injection directly into the tendon sheath. This anti-inflammatory medication is highly effective for many patients, providing relief in 50% to 90% of cases, especially when administered early.
If conservative treatments fail to provide lasting relief after several months, surgical intervention may be considered. The outpatient procedure involves releasing the roof of the constricted tendon sheath, creating more room for the inflamed tendons to glide freely. Following surgery, patients typically wear a splint for one to four weeks and begin hand therapy to regain full strength and movement. Complete recovery generally takes between six and twelve weeks, but the procedure offers a permanent resolution for symptoms that did not respond to non-operative management.