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Apr 11 2012

A Case of the Mommy Thumb

By at 11:06 am

mommy thumbI’m pregnant again, so you know what that means. I am worried about my thumbs.

See, the first time around, I worried about the stuff you typically associate with pregnancy: stretch marks, weight gain, and other TMI-type stuff. Luckily, I came out fairly unscathed–if you don’t count the emergency C-section and inability to breastfeed. What I never counted on–or was warned about–was the excruciating pain in the spot where my left thumb meets the wrist that started less than two months after Ellie arrived.

I went to an orthopedist who diagnosed it as Mommy Thumb. The technical term is De Quervain’s tendinitis. It means that the group of tendons running from your wrist into your hand that are responsible for moving the thumb have swelled to the point of causing friction within their sheath. They rub against the sheath causing pain and in extreme cases like mine, a horrible popping sensation that feels like the tendons are snapping out of place.

The doctor administered a shot of cortisone (safe because I wasn’t breastfeeding) and put me on a weeklong regimen of prescription anti-inflammatories. The pain returned about a month later. It was so bad I thought I would drop my daughter, who was by then maybe 10 or 12 pounds. I could hardly get her in and out of her crib. Washing my hair or putting it in a ponytail became a torture session. Even opening a jar became impossible because I couldn’t grip anything with my left hand.

The doctor gave me another cortisone injection The next step, he said, was surgery. So, you can imagine how happy I was when the pain disappeared and all was well for about six months. Then I felt a twinge again. It wasn’t long before that familiar slight jab became a full-fledged stab that interfered with my life.

I went to another doctor for a second opinion since I knew the first guy would want to cut me open. This doc gave me a prescription anti-inflammatory cream to rub on the affected area twice a day. I had to leave it for about 20 minutes and wash it off, being careful not to get it on my clothes or on Ellie, so that was convenient. He also put me in a sturdier wrist brace that basically removed movement in my wrist and thumb and told me to take off the brace only to shower and apply ice four times a day, also convenient.

I went back to his office four weeks later with no change. He sent me for an MRI and put the surgery wheels in motion. I ended up on the operating table of another physician–a hand specialist at Georgetown University–in February 2011, almost a year to the date of my first diagnosis.

My surgeon, Scott Edwards, said pregnancy-induced hormonal and fluid changes get the ball rolling on the condition, but it’s usually not until the baby is out and the mom is doing new repetitive motions such as lifting and carrying the child that the pain kicks in. It’s often considered a repetitive stress injury because the new movements are making moms use their hands in unfamiliar ways.

There’s no way to avoid the condition, Edwards said. Usually isolating the wrist and thumb and taking some anti-inflammatories do the trick in curing the problem. For those who need more, the cortisone shots are a very common solution. Only rare cases go all the way to surgery. Lucky me.

The surgery involves opening the sheath around the inflamed tendons to give them more room to move around. The idea, Edwards told me, is that they can be inflamed forever and ever if they want but they won’t cause a problem because they have the space to slide.

I opted to do my surgery as an outpatient, and it was pretty straightforward. Recovery was a little more involved than I had counted on. It involved my wearing a cast halfway up my arm for 10 days that I could not wet. I also had to keep the hand elevated at all times. My husband took a week off of work to deal with our then-1-year-old, and my mother-in-law came to help the second week.

After about six to nine months and several rounds of physical therapy, I have most of my range of motion and strength back. Edwards said the surgery is 95 percent effective and this shouldn’t recur with another pregnancy. But the odds haven’t worked in my favor so far with this condition, so I’m worried my wrist will find a way to join that five percent who do get it again. Or that my right wrist will be jealous of the inch-long arrow-shaped scar on my left wrist and I’ll be affected in that hand instead.

When all of this went down, I was frustrated that no one–including my doctors and the pregnancy books and websites I read–had told me about Mommy Thumb. In fact, no one I knew had ever had it even though it turns out to be a fairly common condition. Knowing about it wouldn’t have stopped it, but at least I wouldn’t have felt so blindsided. I write about it here to let other women know what I didn’t.

Now 19 weeks into gestating Baby 2, as I start to think about finding out the gender and when I want to schedule my C-section, I am also thinking about my wrists and hoping they behave themselves.

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