De Quervain's tenosynovitis — new-mother wrist pain explained (Seremban & Nilai)

De Quervain's tenosynovitis is an irritation of two thumb tendons (abductor pollicis longus and extensor pollicis brevis) as they pass through a tight sheath on the thumb-side of the wrist. Classic presentation: sharp or aching pain on the thumb side of the wrist, worse when lifting baby under the armpits, picking up a cup, opening a jar, or wringing cloth. Sometimes tender swelling at the base of the thumb. Why new mothers? A perfect storm: hormonal laxity post-pregnancy, repeated lifting with the wrist deviated sideways (classic under-armpit baby lift), breast-feeding positions that hold the thumb abducted, and sleep deprivation which slows recovery. Commonly seen in our Seremban 2 and Nilai clinics in these groups: Bandar Sri Sendayan young families, Nilai university staff families, Seremban office workers returning from maternity leave, and Port Dickson retirees looking after grandchildren. Not every thumb-side wrist pain is De Quervain's — we also screen for CMC joint arthritis, scaphoid issues, and referred pain from the neck.

The Finkelstein test is a useful home screen, not a final diagnosis. How to do it: place your thumb in the palm of the same hand, close your fingers over it to make a fist, then slowly tilt your wrist down toward your little finger (ulnar deviation). If this reproduces a sharp pain on the thumb-side of the wrist, De Quervain's is likely. A negative test does not fully rule it out, and a positive test does not rule out other problems — imaging (ultrasound) is sometimes added when diagnosis is unclear or when symptoms fail to settle in 6–8 weeks. If your pain is mainly at the base of the thumb (not the side of the wrist), worsens with pinching, and is common in older adults, it may be CMC joint osteoarthritis instead. If you had a recent fall onto the wrist with sharp pain on the thumb side of the wrist, please go to Hospital Tuanku Ja'afar (HTJ) A&E same day to rule out a scaphoid fracture — missed scaphoid fractures heal poorly.

Step 1 — load management. Change the aggravating move: lift baby from the trunk with both palms supporting, not under the armpits with thumbs out. Support the baby's head in the crook of your elbow during feeds. Avoid one-handed carry on the painful side. Step 2 — splint. A thumb-spica splint (available at KPJ Seremban, Mawar Medical, or most Seremban pharmacies) worn during high-load tasks and at night often settles pain within 2–3 weeks. We do not recommend 24/7 splinting beyond the acute flare — it weakens the surrounding muscles. Step 3 — graded exercise. Once pain is calmer (usually week 2–3), we add isometric thumb holds, progress to controlled dynamic range, then loaded tasks. This rebuilds tendon tolerance so it does not flare again at the next growth spurt. Step 4 — other adjuncts. Corticosteroid injection (usually via hand clinic at HTJ or a Seremban/Nilai specialist) is reasonable for persistent cases; shockwave has some evidence; topical NSAIDs help some patients. Surgery (first-compartment release) is reserved for cases that fail 6+ months of good conservative care.

Most De Quervain's settles with physio — but please go to Hospital Tuanku Ja'afar (HTJ) A&E same day if you have any of the following: (1) recent fall onto the wrist with sharp pain on the thumb-side — rule out scaphoid fracture; (2) hot, red, swollen wrist with fever — rule out septic tenosynovitis; (3) sudden numbness or weakness in the hand, pale or blue fingers; (4) pain so severe you cannot sleep or hold your baby safely; (5) post-surgical wound that is red, leaking, or increasingly painful. Outside those, book a physio review. Bring your baby — we are happy to watch feeding and carry positions, because the fix often lives there, not in the wrist itself.