Mommy Thumb

There are tendons that run along the thumb side of the wrist that course through a small compartment adjacent to the forearm bone, radius, that function by extending or pulling the thumb outward. These tendons are covered by tissue, tenosynovium, that bathes the tendon with a lubricant that facilitates gliding of the tendon through this tight space.

With repetitive use of the thumb or in some cases a specific injury, an increase in inflammatory tissue develops which reduces the space within this compartment leading to an increase in tendon friction which causes pain.

For decades people have been afflicted with this condition, known as de Quervain’s tendonitis. In recent years with the development of PDA’s or small electronic devices that allow frequent data input in the palm of the hand for texting or emails, this condition has been referred to as “Blackberry Thumb”.

Recently, this condition has been showing up more and more in mothers with newborns and is now being called “Mommy Thumb”.

Mommy thumb may develop in the last trimester of pregnancy when mothers typically retain fluid which can lead to swelling within compartments in the hand and wrist. The most common condition affecting the hand and wrist during pregnancy is carpal tunnel syndrome. Usually these conditions resolve after pregnancy as swelling subsides.

Mommy thumb usually develops after delivery over the first year of the newborn’s life from forceful or repetitive grasping of the infant while lifting the infant up or frequently carrying the infant. I am also seeing more and more mothers with this condition that are breast feeding and holding their wrist in an awkward position while cupping the breast.

Add a blackberry or an iphone use to a nursing mother, places the mother at significant risk of developing mommy thumb.

Pain at the thumb side of the wrist increased with thumb or wrist flexion or extension. Pain may radiate to the top of thumb or up the forearm. Swelling at the thumb side of wrist. May have a bump. May have tingling to top of hand.

Tenderness and swelling at the thumb side of wrist. Pain increased with resistance to thumb extension. Pain with clasping the thumb and bending the wrist towards the little finger side of wrist (Finklestein’s test). In severe cases, a grinding may be present at the thumb side of the wrist with thumb movement and thumb movement may be limited.

Non-surgical treatment of mommy thumb?

The initial treatment normally would be to remove the cause and to rest the wrist as much as possible. While it may be hard to give up the texting, a mother can’t stop caring for her baby.

The medical treatment initially consists of NSAID’s such as advil or aleve and a splint or brace (again hard to do for mothers and effectively care for a baby). Therapy may also provide some relief. However, the most effectice treatment is a Celestone steroid injection (most pediatricians are approving of this for nursing mothers) into the compartment followed by a brace for 2 weeks which provides long term relief in about 50% of cases.

Surgical treatment of mommy thumb?

If after at least one injection, conservative treatment has not been effective, probably the easiest tolerated wrist surgery done is a 5 minute, stitchless ,outpatient procedure through a minimally invasive 1cm incision under a local anesthetic where the band over the compartment is snipped relieving pressure. There is no loss of function as a result of dividing this band. After a few days in a splint, there is a quick recovery of a few weeks to get back to normal activities.

Dr. Knight has over 25 years of experience in treating mommy thumb. While he cures most of these cases with conservative treatment, he has performed thousands of these procedures through minimally invasive techniques to minimize scarring and to return his patients back to an active lifestyle in no time.

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