Mother's Thumb

Mother’s Thumb, Gamer’s Thumb, De Quervain’s Disease (DQD) or Tenosynovitis are all similar terms for a specific type of pain around the back of the thumb and thumb-side of the wrist. It is called Mother’s or Gamer’s Thumb because it is caused by repetitive motions of moms picking up their infants underneath the armpit or gamers playing with a controller. The pain can also happen when opening a jar, lifting weights, wringing a towel, typing, texting, and more.

What is it?

DQD is an injury to two tendons (Abductor Pollicis Longus and Extensor Pollicis Brevis). If you reach your right hand out like you’re about to shake someone’s hand, they are located from the base of the thumb to the outside of the wrist. It is caused by repetitive microtrauma that creates a thickening of the tendons and the sheath of tissue that they are enclosed in. 

Imagine a little tunnel of tissue that the tendon runs through, like a noodle in a straw. Now imagine that the noodles are cooked and swell up. They get trapped in the straw. Similarly, the tendons are trapped in the tendon sheaths when they are overused, causing pain.

It is most common in women in their 30s to 50s. DQD has a prevalence of 0.5% in men and 1.3% in women. One way you will know you have symptoms of DQD is through a test where you put your thumb under the rest of your fingers into a fist and move your wrist so you are stretching your thumb. If this immediately causes pain, you might have DQD. 
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​What can I do about it?

A physical therapist or orthopedic specialist can diagnose DQD clinically with a few tests to get you the proper care. 

Rest
For new moms who are experiencing pain with lifting their infant, changing the way you lift the baby (perhaps cinderella style instead of under the armpits) can resolve symptoms automatically. Avoiding painful activities is a must to allow the tendons to heal. Your physician might suggest that you take anti-inflammatory medication or receive corticosteroid injections as a treatment option to alleviate pain early on. 

Neutral Alignment
If you feel pain, it’s important for your wrist to be in a relatively “neutral” alignment when possible. This means, if you look at your palm, your middle finger is basically aligned with the length of your forearm. Splinting might be an option for you to prevent your wrist and thumb from going into painful positions. However, you want to make sure you don’t immobilize the wrist for long periods to avoid muscle atrophy. 

Manual Therapy and Exercise
A PT or an occupational therapist (OT) can do soft tissue manipulation to release tight muscles, drain fluid build up, and desensitize painful areas. If you have had a surgical release of the tendon sheath to decompress pressure, you will also receive manual therapy post-operative to manage the scar tissue. Your PT will prescribe you pain-free exercises and stretches to start the healing process. 

Activity Modification
If your pain is from working at a desk and typing, an ergonomic check is necessary to set you up with adaptive equipment that doesn’t put as much strain on your wrist and thumb. If your pain is only on one wrist, then I suggest switching to the pain-free side when possible with certain activities, like lifting a gallon of milk. 

Last Thoughts.

Pain at the wrist and thumb can be frustrating when you need to use them throughout the day for all sorts of activities. However, it’s important to receive the proper care without brushing off the pain. By addressing DQD early on with conservative care, you can prevent further degeneration of your tendons and the expensive surgeries, injections, and medications that come along with it. As with all injuries, use your pain as a guideline! If it hurts, stop and see a specialist.

References:

1. Goel R, Abzug JM. de Quervain's tenosynovitis: a review of the rehabilitative options. Hand (N Y). 2015; 10(1):1–5.
2. Huisstede BMA, Henk Coert J, Fridén J, Hoogvliet P. Consensus on a Multidisciplinary Treatment Guideline for de Quervain Disease: Results From the European HANDGUIDE Study. Physical Therapy. 2014; 94(8):1095-1110. 
3. Papa JA. Conservative management of De Quervain's stenosing tenosynovitis: a case report. J Can Chiropr Assoc. 2012; 56(2):112–120.
4. Satteson E, Tannan SC. De Quervain Tenosynovitis. [Updated 2018 Nov 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK442005/

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