Wrist pain

Does your wrist hurt when you breastfeed? You might be affected by de Quervain's tenosynovitis, explains Elizabeth Gasson.

One of the best parts of being a mum is the closeness that comes from being able to breastfeed your baby, scoop him into your arms when he needs comforting, and just cuddle him any old time of day. But one day, around the time of my son's first birthday, I was sitting on the floor with him while he tried to take a few steps on his own. He fell into my arms and I lost my balance, putting my hand on the floor to steady myself.  No big deal, right?

Later that evening, I felt a few twinges of pain in my hand, and assumed I'd pulled a muscle. But the next day,  I could no longer pick up items from the floor, make a fist, or pick up my baby boy. Breastfeeding was excruciatingly painful because my wrist felt like it was broken. The pain kept me up nights, and certain activities brought tears to my eyes. At one point, when I tried to pick up a glass of water, my wrist felt like it had snapped and I dropped the glass.

This was the final straw. I contacted a physiotherapist, who booked me in for an appointment immediately. After only a few minutes of hand exercises and range-of-motion tests, she asked me if I had a new baby. I was surprised - how did she know? After surreptitiously looking for baby food stains on my T-shirt, I admitted that yes, I was a new mother, but what did that have to do with my wrist? She then informed me that I had a condition called De Quervain's tenosynovitis, also known as "breastfeeding wrist" or "housewives' wrist".
Breastfeeding wrist is a painful condition where by the sheath of the wrist's tendons becomes inflamed and swollen. Because of the swelling, the tendons and their covering rub against the narrow tunnel in which they sit, causing more swelling and scar tissue to build up, thus restricting the tendons' movement.

I was told that one of the main causes that brought this condition on was breastfeeding my baby (that is, a repetitive motion), even though my son was actually quite small for his age and only weighed 8.5kg before his first birthday.

A common breastfeeding position has the baby cradled in mother's arms, mother's wrist bent at a right angle, with the weight of the baby's head pushing down on the arm and wrist. This pressure, coupled with the acute angle and repetitive nature of the action, leads to the inflammation of the wrist. I also realised that other actions, such as pushing the buggy and bracing myself on the floor with my wrist in that unnatural position did not help!

 I was told that the best thing I could do was to rest my wrist and avoid using it as much as possible. This was very hard to do, as I could not stop lifting my baby. Despite six or so sessions of physiotherapy, the pain continued to get worse.

I was sent to a hand clinic, which put my arm and wrist into a cast designed to help correct the position of my wrist by immobilising it for six to eight weeks. The cast had a split down the centre so it could be removed if need be. They also showed me how to feed my baby while making sure my wrist was straight and not in the acute angle. Using a pillow to help support my son's body and head also helped.

However, due to the swelling in my wrist, I was also referred to a hand surgeon, to be assessed whether the more drastic step of surgery was my only option.

The surgeon examined my arm by asking me to make a fist with my thumb tucked under my fingers, then turn my hand and lower my wrist towards the floor. I just about cried. I could not do the action at all.

He explained that I had scar tissue around the tendons meaning that they could no longer glide through their natural movement. He would have to open up my wrist and scrape out the damaged scar tissue. This would all be done under a local anaesthetic, and I would not be able to use that arm for about two to three weeks while it healed. I didn't know how I was going to cope with that. I wouldn't be able to bathe my son, change his nappies with both hands, or, for that matter, wash myself without some difficulty.

I went away and spoke to my husband and my mother, and we devised a plan. My husband would bathe my son every day, and my mother would help me to look after him as much as possible. I also made a huge effort in correcting my wrist position when breastfeeding. This plan meant I could seriously rest my wrist and the pain started to decrease. After a further six weeks the pain had greatly reduced, and I no longer needed the surgery.
This was a very frustrating, and painful experience for something which, with knowledge, could have been prevented. It is important that when picking up your baby, breastfeeding (or bottle-feeding), even pushing the buggy and carrying a baby capsule, that we make sure we do not unnaturally put our wrists into a bad position.

And Dads, you are not immune to this. If you are helping with these activities, you are also at risk.
If you are aware of any discomfort or pain in your wrist, thumb or forearm, it is best to contact your physiotherapist as soon as possible. They are able to assess and diagnose this or similar conditions that will respond to treatment. It is very important to receive treatment as soon as possible for the most efficient recovery - especially important to a busy mum or dad.