Your baby is 6 weeks old. You’ve been lifting them 20-30 times per day, from the crib, from the car seat, from the bath, from the playmat. Your thumb-side wrist started aching two weeks ago. Now it’s sharp pain every time you lift your baby. You can’t grip a bottle. Changing a nappy hurts. Wringing a cloth to clean the baby’s face is agony.
Welcome to de Quervain’s tenosynovitis, the “new mother’s wrist.” It affects up to 50% of new mothers in the postpartum period (Journal of Hand Therapy, 2009). The combination of hormonal changes (relaxin loosens ligaments), fluid retention, repetitive lifting, and a new gripping pattern (the “L-shaped” hand position used to support a baby’s head) creates the perfect storm for this tendon injury.
The cruel irony: the treatment for tendon injuries is rest. But you can’t rest when a newborn needs to be lifted, fed, changed, and held 24 hours a day. This is where OT provides what no other medical professional does, treatment that works while you continue to care for your baby.
Wrist pain from lifting your baby? OT treats it without stopping you from caring for your child.
What De Quervain’s Is
De Quervain’s tenosynovitis is inflammation of the tendons on the thumb side of the wrist, specifically the abductor pollicis longus and extensor pollicis brevis tendons where they pass through a narrow tunnel (the first dorsal compartment).
Symptoms:
- Sharp pain on the thumb side of the wrist
- Pain when gripping, pinching, lifting, or twisting
- Swelling at the base of the thumb
- A “creaking” or “catching” sensation when moving the thumb
- Pain that radiates up the forearm or down into the thumb
The Finkelstein test: Make a fist with the thumb tucked inside, then bend the wrist toward the pinky side. If this produces sharp pain on the thumb side, de Quervain’s is very likely. (Note: this test is painful even in mild cases, don’t force it.)
Why New Mothers Are Vulnerable
Hormonal Changes
Pregnancy hormones (relaxin, progesterone) loosen ligaments and tendons, making them more susceptible to injury. These hormonal effects persist for months postpartum, especially while breastfeeding.
Repetitive Lifting Pattern
The “baby lift”, spreading the fingers wide, thumbs abducted, scooping under the baby with an L-shaped hand, loads the de Quervain’s tendons maximally. Performed 20-30 times daily, this pattern exceeds the tendon’s capacity quickly.
Breastfeeding Position
Holding the baby for breastfeeding often involves sustained wrist extension and thumb abduction with the supporting arm. A 30-minute feed, 8-12 times daily, accumulates hours of tendon loading.
Sleep Deprivation
Fatigue reduces muscle coordination and increases grip force (you grip harder when tired because you’re less precise). This additional force accelerates tendon damage.
How OT Treats De Quervain’s in New Mothers
1. Thumb Spica Splint
The primary treatment: a custom-moulded splint that immobilises the thumb and wrist while allowing finger movement. This rests the inflamed tendons while you continue to use your hand for daily tasks.
Key design for mothers:
- Must allow finger flexion (so you can still grip and hold the baby)
- Must be washable (baby spit-up, milk, water)
- Lightweight and low-profile (doesn’t interfere with baby handling)
- Removable for bathing and specific exercises
Wearing schedule: 4-6 weeks of near-continuous wear, removing for prescribed exercises and hygiene. A 2018 study found that 70% of new mothers with de Quervain’s achieved resolution with splinting alone.
Cost: RM80-200 for a custom splint at a private OT clinic.
2. Modified Baby-Handling Techniques
This is the intervention unique to OT, changing how you lift, hold, and feed your baby to reduce tendon load:
| Current Technique | Modified Technique |
|---|---|
| L-shaped hand under baby (thumb spread wide) | Scoop under baby with palms flat, fingers together, thumb alongside, not spread |
| Lifting baby with wrists bent back | Lift with forearms and elbows, keeping wrists neutral |
| One-hand lift from crib | Two-hand lift: one under head, one under bottom |
| Gripping baby’s body with fingers and thumb | Support baby on forearms, not in hands |
| Breastfeeding with arm as sole support | Nursing pillow under baby, arm rests on pillow (wrist not loaded) |
The OT demonstrates each modified technique with a doll or with your actual baby, practises with you until the new technique is automatic, and checks at follow-up that you’re maintaining it.
3. Exercises
During acute phase (with splint):
- Gentle thumb and wrist range of motion (2-3 times daily, 10 repetitions)
- Tendon gliding exercises (5 positions, 10 repetitions)
- Ice after exercise (10 minutes)
After splint weaning:
- Eccentric wrist extension exercises (same principle as tennis elbow treatment)
- Gradual grip strengthening with theraputty
- Thumb-specific strengthening (opposition exercises, pinch exercises)
4. Activity Modification Beyond Baby Care
| Activity | Modification |
|---|---|
| Wringing cloths | Press instead of wring, or use a towel wringer |
| Opening jars | Use opposite hand, or jar opener |
| Cooking (stirring, chopping) | Lightweight utensils, opposite hand, food processor |
| Phone scrolling | Opposite hand or phone stand (avoid sustained thumb swiping) |
| Carrying bags | Forearm carry, not hand grip |
Treatment Timeline
| Week | What Happens |
|---|---|
| 1 | Assessment, custom splint, modified baby-handling training |
| 2-4 | Splint wear, gentle exercises, technique consolidation |
| 4-6 | Reassessment, if improved, begin splint weaning (night only) |
| 6-8 | Gradual strengthening, full activity resumption |
| 8-10 | Final assessment, splint discontinued, home exercise programme for maintenance |
Total sessions: 4-6 over 8-10 weeks. Cost: RM560-1,400 including splint.
When Additional Treatment Is Needed
If splinting and activity modification don’t resolve symptoms by 8-10 weeks:
Cortisone injection: Effective in 80-90% of cases. The OT coordinates with your doctor, the injection reduces inflammation, creating a window for more effective rehabilitation.
Surgery: Rare for postpartum de Quervain’s. Reserved for cases that fail 3-6 months of conservative treatment. The surgery (tendon sheath release) is minor and done under local anaesthesia.
Frequently Asked Questions
Is it safe to splint while breastfeeding? Yes. The splint is designed to allow finger movement for holding and positioning the baby. Breastfeeding should actually improve with the splint because the nursing pillow modification reduces the need for wrist support.
Will it come back with my next pregnancy? Possibly, the same hormonal and mechanical factors will be present. Preventive splinting and modified lifting techniques from the start of the next postpartum period can reduce recurrence risk.
Can I just buy a splint from the pharmacy instead of seeing an OT? Pharmacy splints rarely fit correctly for de Quervain’s, most are generic wrist splints that don’t immobilise the thumb sufficiently. A custom OT splint immobilises exactly the right joints while allowing maximum function.
You Can’t Stop Caring for Your Baby. But You Can Stop Injuring Yourself Doing It.
De Quervain’s doesn’t require you to stop lifting your baby, it requires you to lift differently, support the tendons with a splint, and allow healing while maintaining full function as a mother.
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