By: Maggie Gebhardt, PT, DPT, OCS, FAAOMPT
As a new mom myself (I have an 18-month-old son), this topic/diagnosis has been on my mind recently. New parents place so many biomechanical demands on their bodies while we are assuming many different and awkward positions. These are often unaccustomed and repetitive or sustained positions, i.e. a fussy baby who has finally fallen asleep, forcing you to stay right where you are no matter how uncomfortable for fear of waking up your child!
DeQuervain’s Tenosynovitis is often a diagnosis given to new parents with sudden onset of thumb pain. Their physical therapist may explain that their lifting mechanics when picking up their baby, are incorrect with too much radial deviation at the wrist, thus causing increased stress and irritation at the tendons crossing their CMC joint. As a clinician, I was also guilty of coming up with this diagnosis and It was not until I became a parent myself, that I realized there was so much more to it than that!
There are at least six muscles that can refer pain to the area of the thumb (can you name them?) and maybe only a few that can be impacted with excessive radial deviation. Of note, almost none of these are actually thumb muscles! However, when you look at this group of muscles, they can all be affected in the caring of a new baby and the unaccustomed demands we are placing on ourselves. Let’s run through the list:
- Supinator- supination of the forearm. Any type of lifting/holding/carrying/feeding with the wrist in a supinated position targets this muscle. This position happens all too much when caring for babies!
- Scalene- accessory breathing muscle. Women who are breastfeeding are especially prone to trigger points in this muscle due to poor posture in certain feeding positions. Also, carrying a baby over your shoulder for prolonged periods of time can cause trigger points here.
- Brachialis- powerful elbow flexor. Carrying a baby in the crook of your arm for prolonged periods of time can aggravate, but also awkwardly carrying a baby carrier causing sustained elbow flexion can aggravate.
- Brachioradialis- another elbow flexor that is most active with the wrist in neutral. Again, very involved with any type of lifting i.e. out of a car seat, bathtub, high chair, etc.
- Opponens & Adductor Pollicis- both bring the thumb closer to the hand in their respective planes. These muscles are going to develop trigger points with any type of forceful or excessive gripping, i.e. carrying a car carrier.
I recently treated a new grandmother, who had just come back from helping to care for her new grand baby and was having a lot of thumb pain. She had been worked up by her doctor with no resolution. After taking a look at her and chatting with her regarding the timeline of her symptoms I began to think that she was suffering from what I coined, “New ‘Grand’parent Syndrome.”
We spent some time needling the above muscles and within a couple of visits her pain had resolved. We discussed proper lifting and carrying techniques/postures when helping with her grandchildren and for the most part she is now able to manage things on her own. Don’t forget to think of this condition across the lifespan and remember how much stress caring for a little one can place on all our bodies no matter the age! Most importantly, remember that trigger points may not be where the pain is manifesting. Make sure to find the source and just don’t treat the painful area itself!
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Just a few references….
Troy K. Rubin, Luke A. Henderson,and Vaughan G. Macefield: Changes in the Spatiotemporal Expression of Local and Referred Pain Following Repeated Intramuscular Injections of Hypertonic Salinongitudinal Study. The Journal of Pain 11(8):737-745, 2010
Troy K. Rubin, Simon C. Gandevia, Luke A. Henderson, Vaughan G. Macefield: Effects of Intramuscular Anesthesia on the Expression of Primary and Referred Pain Induced by Intramuscular Injection of Hypertonic Saline. The Journal of Pain, 10(8): 829-835, 2009