Monday, September 27, 2021

Becoming a new parent is often a weird and wonderful experience. In addition to bonding with a tiny human, a new parent learns new things about human development, about sleeping patterns, and about their own tolerance for being grossed out.

There are also some surprises. Many new parents suffer from common, treatable hand and wrist problems. These can span from the time during pregnancy to well after the baby is born.

The earliest hand problem that can arise is gestational carpal tunnel syndrome (GCTS). Many expectant mothers suffer from this condition without even knowing what it is, but GCTS is very common. It affects 30 to 60% of pregnancies. Symptoms include numbness, burning and tingling in the thumb, index, middle, and frequently part of the ring finger. The underlying reason for the condition is a combination of positional/postural issues (extreme wrist flexion or extension) and swelling within the carpal tunnel, a tightly enclosed space that contains ten tendons and a nerve. The resulting constriction compresses the nerve, causing painful and irritating symptoms, which are often worse at night and usually begin in the second or third trimester.

Thankfully, most cases of GCTS resolve following delivery. Prior to that, initial treatment of GCTS includes wearing a wrist brace to hold the wrist in a neutral position during sleeping and, if needed, during driving or typing. A hand surgeon can perform a steroid injection if bracing isn’t alleviating symptoms. As a last resort, carpal tunnel release surgery can be done. While the administration of anesthetic drugs during pregnancy is certainly a concern, many hand surgeons are now able to perform this procedure using local anesthesia only.

Nerve entrapment issues can still arise after delivery. If you’ve ever been lying in bed reading, or holding a phone or tablet, and your small and ring fingers start to go numb, you’ve likely experienced cubital tunnel syndrome, which is compression of the ulnar nerve at the elbow. This syndrome is typically related to positions of elbow flexion (bending), or of leaning on the inner part of the elbow. It can be prevented or even in most cases cured by avoiding elbow flexion. Side-sleepers are especially vulnerable, as are parents holding and burping babies with their elbows flexed. If you are noticing this symptom, try as best you can to keep your elbows extended. It can help to wear an elbow pad, flipped around backward so the pad is in the front of the elbow to prevent flexion while sleeping. Nerve gliding exercises can also be helpful. Surgery is only considered as a last resort.

Finally, another common issue to arise after the baby is born is De Quervain’s Tendovaginitis (also called First Dorsal Compartment Tendonitis). This is a painful condition of overuse involving two tendons that travel from the forearm to the thumb. The most frequent symptom is pain at the wrist, just at the base of the thumb. This condition is sometimes referred to as “Mommy’s Wrist,” though it can also be seen in anybody who holds a baby frequently, including Daddy, uncles, aunts, zaydas, savtas, etc. Picking baby up underneath the armpits with the palms facing one another can be one cause. Holding the thumb extended with the wrist flexed can be another. Treatments can range from activity modification and bracing to anti-inflammatory medications or steroid injections. Surgery is offered in resistant cases that don’t respond to conservative treatments.

In the overwhelming majority of cases, these conditions do not require X-rays or invasive tests to be performed, and can be diagnosed by a proper physical examination alone. In any of these cases, it can be helpful to consult with a hand specialist prior to developing a treatment plan, as some of these diagnoses can coexist or overlap.

Dr Joseph Rosenbaum is an orthopedic hand surgeon practicing In Westchester. He grew up in Fair Lawn, New Jersey, and now lives in New Rochelle with his wife and three sons.

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