HAND/WRIST
Motherhood is one of the most treasured times in our lives, but it can also be one of the hardest. Our bodies endure so much change during pregnancy to create a tiny being and just when we think the hard part is over, the baby is here. And that is when everything begins!As new parents, we are sleep deprived and trying our best to get by. We don’t even realize what stress we are putting on our body until it is too late, and the pain has arrived. As there are many injuries postpartum, I would like to review about post partum wrist injuries.
The most common wrist injury is Dequervain’s tendonitis, also known as “baby wrist”. This injury is an overuse injury that is caused when your wrist is flexed and ulnar deviated (see image).
Carrying a baby, lifting the baby out of a crib or bassinet, or even feeding a baby, the wrist is normally in this position. As the baby grows, more pressure is stressed through the wrist. The pain is normally located where the thumb and wrist connect but has been known to travel into the thumb. Doctors can diagnose with an exam. Further imaging is normally not required. Treatment options start with a wrist brace that includes the thumb/forearm and anti-inflammatory medications. Therapy may also be prescribed as a next step. Therapy will normally include exercises, massage, taping and ultrasound. If conservative options fail, then corticosteroid is offered as first option and surgery as a last resort.
Carpal Tunnel Syndrome is another common injury. This condition can start during pregnancy but has been known to linger postpartum also. This is caused by compression of the median nerve. As the body changes from weight gain and increased fluid, the pressure from the changes can compress this nerve. The median nerve is located in the wrist, but most of the symptoms that patients feel are in their hands, specifically the thumb, index, middle and half of the ring finger. Common symptoms are pain, numbness, and tingling. Doctors normally can diagnose by just exam but will sometimes recommend an EMG (Electromyography) which will tell them how compressed the nerve is. Treatment normally starts with a wrist brace. If patients are still experiencing symptoms, then 
an injection or surgery (depending on the severity of the nerve compression) can be offered.
Lastly, extensor tendinitis is another common wrist injury that can occur postpartum. This also is an overuse injury caused by increased stress on the tendons. The extensor tendons run dorsally (backside of wrist) from the elbow down to the fingertips. The pain is normally located on top of the wrist also known as the dorsal wrist. Carrying the baby carrier, lifting the baby and holding the baby can put stress on the tendons causing inflammation. Unlike Dequervain’s and Carpal tunnel syndrome, normally this can be treated nonoperatively in the acute stage. Again, treatment starts with a wrist brace and anti-inflammatory medications. If no relief, then hand therapy is usually the next step. Therapy will normally include stretching, exercise, massage, taping and ultrasound. If treatment fails, an injection could also be considered. If all conservative options fail, MRI can be considered to determine if there is any tendon tearing. If tearing has occurred, then surgery could be a last resort.
Although these injuries may not always be avoidable, they are treatable!
References:
https://www.ajronline.org/doi/full/10.2214/ajr.182.3.1820719
