Fish Handler’s Disease

Catching more than you bargained for…..

This blog was inspired by a recent case reporting the improper handling of a stingray.  In this particular case, a man visiting Florida and unfamiliar with the local marine life sustained a hand injury from the barb of a stingray while fishing.  The injury required surgery and years of recovery.

Stingray barbs, sharp and toxic

Stingray barbs, sharp and toxic

Those familiar with stingray know to be particularly cautious.  The barb can be dangerous and wounds sustained from them vulnerable to limb threatening infection.

Though, the stingray with its venomous, razor sharp barb is not the only fish capable of inflicting harmful injury.  The dorsal fins of many frequently caught fish can contain venomous spikes and bacteria exposing open wounds to dangerous infections.

In fact, the teeth and fins of many fish are notorious breeding grounds for bacteria and fungus putting wounds inflicted by them at great risk for infection.

Too often identifying the source of infection, such as that which was found in the above case (Fusarium solani bacteria), can delay proper treatment and result in permanent damage – particularly if the medical team treating the injury is unfamiliar with the region or marine life responsible for the injury.  This patient was eventually treated with debridement and skin grafting in conjunction with ketoconazole therapy (antifungal treatment). 1 Unfortunately recovery took years.

Understanding the marine life in your area and those fish of particular concern will help reduce these types of injuries – and facilitate the healthcare team involved in your care should an injury occur.  Also knowing some first quick steps in addressing such an injury before seeking medical attention can improve outcome.

Swimming with Bacteria

Fish fins and teeth, breeding ground for bacteria

Fish fins and teeth, breeding ground for bacteria

Aquatic fungi are often considered secondary tissue invaders following traumatic injuries or infectious agents. Because many fungi grow on decaying organic matter, they are especially common in the aquatic environment, particularly in warmer waters.  A number of mycotic infections have been reported in fish. Laboratory culture and complete clinical evaluations will further the understanding of these diseases – initially for scientists and then healthcare providers treating such injuries.  The education of sportsmen can go a long way in filling the gap in between.

The prevalence of infections resulting from Mycobacterium marinum bacteria or Erysipelothrix in those handling fish and shell fish has prompted the official classification now known as Fish Handler’s Disease.  

More than an Open Wound

Whether it occurs while unhooking, filleting or tossing back to the sea, when the skin is broken by a tooth or fin (particularly among those fish identified as toxic or high bacteria carriers), the injury has a far more damaging potential than a simple, open wound.

The largest organ of the human body, skin serves a valuable protective purpose for all that lies beneath – ensuring not only that our internal network remains intact but also that nothing harmful or disruptive gets in.  When this protective barrier is breached, not only is the wounded limb affected but the entire body.  Invasive bacteria and fungal infections can spread quickly.

While addressing the initial wound, such as stopping blood loss and addressing pain, taking quick steps to reduce risk of a disseminated infection or invasive impact of a venomous/toxic encounter are key to a rapid recovery and reduction in longterm trauma.

A disseminated infection is an infection that enters at a single point and then spreads throughout the body, often affecting numerous organ systems such as that incurred by a stingray and other venomous fish. Beginning as a lesion, the injury gets progressively worse as the infection grows.  The right emergency care and ongoing treatment are key.

Immediate Action Following Toxic Exposure

Whether an open hand wound results form exposure to a known toxic barb or local Catfish fin, following these early steps will help in the ultimate healing process:

  • Bathe the wound in saltwater, removing any fragments of the spine
  • Stop the bleeding by applying pressure
  • Soak the wound in hot water until the bleeding stops, or apply a heat back. This will inactivate any venom still in the wound. Remove any pieces of the spine/fin/barb in the hand with sterilized tweezers (not advised if in the chest, abdomen, or neck).
  • Clean the wound with soap and water and dress it without taping it closed
  • Immediately go to the hospital or ER
  • Inform the medical staff of the area in which you were fishing and the type of fish you were handling

Preventing Fish Handler’s Disease and other Fishing Trauma

While not every incident during a fishing trip can be controlled, there are some things we can do to reduce risk of injuries escalating to more harmful levels.

These Include:

  • Wearing fishing gloves
  • Covering limbs with long sleeves/pants
  • Utilizing de-hooking devices while handling marine life
  • Washing hands and equipment after handling any fish, or after any exposure to open water

Reference

1.) Hiemenz JW, Kennedy B, Kwon-Chung KJ.  Invasive fusariosis associated with an injury by a singray barb.  J Med Vet Mycol. 1990;28(3):209-13.

Interesting and Informative Reading

http://www.wideopenspaces.com/ouch-the-7-common-fishing-injuries/

http://handlinefishing.com/whatsthisfish/dangerousfishes.htm

http://handlinefishing.com/whatsthisfish/dangerousfishes.htm

http://www.merckmanuals.com/vet/exotic_and_laboratory_animals/fish/mycotic_diseases_of_fish.html
http://www.drjball.com/article6.html

 

Hand and Wrist Pain in Exercise – Can Make it Hard to Power Through

Hand and wrist pain in exercise can affect men and women, young and mature alike.  From weightlifting and exercise machines to pushups, injuries and conditions can result from the repetitive stress of the activity or the sudden frequent exposure (training in an off season, sudden increase in weights or repetitions, new exercise program, etc.).

Powering Through

Exercise Impact on the Hand & Wrist

The hand and wrist conditions most commonly associated with these types of exercise regimens is tendinitis. Other less common injuries include stress fractures of the wrist.

If not addressed, pain and restricted hand and wrist function could hinder proper form during the activity and cause more serious injury.

Tendinitis – Symptoms and Diagnosis

Tendinitis is the inflammation of the tendon resulting from micro-tears that occur when the “musculotendinous unit” (muscular and tendinous tissue and its ability to be stretched) is severely overloaded with a excessive or sudden tensile force (resistance of a material to a force tending to tear it apart).

It can also be associated with Tendinosis, which is the degeneration of the tendon’s collagen in response to chronic or repetitive overuse.

Symptoms can vary depending on the area affected.  When affecting the fingers, symptoms can be similar to those experienced with trigger finger – catching or locking when bent.

Occurring where a tendon attaches to bone, other symptoms of tendinitis include:

  • Pain and/or tenderness in the hand or wrist when lifting weights
  • Possibly mild swelling

Tendinitis is confirmed upon physical examination and discussion of patient history.  It is generally resolved by resting and refraining temporarily from the activity causing the strain.  If this does not resolve the condition, anti inflammatory medications and hand therapy exercises may be recommended.  Only in extreme cases of tendon damage is surgery considered.

Stress Fractures – Symptoms and Diagnosis

A stress fracture is an overuse injury which occurs when muscles become fatigued – unable to absorb added shock therefore transferring the stress overload to the bone.  This can cause a tiny crack in the bone and is called a stress fracture.  While stress fractures are most commonly seen in the lower extremity, they can occasionally occur in the wrist when subjected to excessive strain or repetitive stress activity such as increasing the amount or intensity of an activity too rapidly.

A stress fracture can sometimes be confirmed on an x-ray, though may not be visible for several weeks despite the pain.  If necessary, a computed topography (CT) scan or magnetic resonance imaging (MRI) may be indicated to confirm the fracture.

Among the most effective treatments for a stress fracture is rest from the activity that caused the fracture for approximately six to eight weeks.  Resumption of activity before proper healing can result in a more serious fracture and potentially chronic problems.

Reducing Risks

There are a number of things that those engaged in weightlifting or related exercise program can do to reduce these types of hand and wrist injuries and conditions.

  • Build up gradually to increased weight and reps
  • Wear wrist guards or protective gloves (minimizing pressure and providing wrist assist)
  • Taking breaks to rest the hands and wrist
  • Using proper technique/form  

Learn more about common hand and wrist injuries and conditions. 

 

 

Skier’s Thumb, Don’t Let it Slow Down Winter Fun

Winter adventures can be some of the best we’ll have all year – from a cross country hike around snowy mountains to skiing down their slopes.  And while not the worst injury that could occur, skier’s thumb is among one of the more common hand injuries associated with these winter sports.  If not properly treated it can affect pinch and grip strength, hindering overall hand function and predisposing the joint to chronic instability and osteoarthritis.

What is Skier’s Thumb

Skier’s thumb, which is also referred to as a thumb sprain or Gamekeepers thumb, is an

Ulnar collateral ligament damage

Skier's Thumb, Ulnar Collateral Ligament Damage of the Thumb's MCP Joint

injury to the ulnar collateral ligament (UCL) of the thumb’s metacarpal phalangeal (MCP) joint.  It is the result of forced abduction or hyperextension of the proximal phalanx of the thumb, caused by abnormal pulling of the thumb, such as in a fall, while affixed to the ski pole/hoop.  While this type of injury is often seen among skiers, it is also frequently seen in athletes or those sustaining a fall on an outstretched hand.

Signs of Injury to the Ulnar Collateral Ligament Include:

  • Pain at the base of the thumb between the thumb and index finger
  • Swelling of the thumb
  • Weakness pinching or grasping
  • Tenderness along the index finger side of the thumb
  • Blue or black discoloration of the skin over the thumb
  • Thumb pain that worsens with movement in any or all directions

Diagnosing Skier’s Thumb

A physical examination and patient history are used in diagnosing this condition. To determine the extent of damage to the UCL, the thumb is moved in various positions to assess stability of the thumb joint.  A stress x-ray may be recommended to confirm that there are no broken bones.

Treatment and Rehabilitation for Skiers Thumb

Treatment for Skier’s Thumb depends on the extent of the damage.  Most cases respond well to conservative, nonsurgical treatment, which may entail immobilization in a cast initially – followed by a splint for a total of six weeks.

If the UCL is completely torn, surgery may be indicated to reconnect the ligament to the bone and restore range of motion and full thumb function.  Any bone damage that occurred during the tear is also repaired during this time.  Following surgery, patients are put in a splint and undergo range of motion exercises with protected activities for four to six weeks. This is then followed by conditioning and strengthening of the thumb.

Handlebar Hazards

Repetitive Stress Hand & Wrist Conditions Affecting Cyclists

As training begins for the upcoming MS150, we thought we’d talk about some of the common overuse, or repetitive stress, hand and wrist conditions affecting cyclists.  By discussing some of these conditions and ways to reduce your risk, hopefully we can ensure pain free cycling and play a hand in many successful rides.

How Repetitive Stress Occurs
Avid cyclists competing year round in weekend rides and races tend to experience various types of overuse strains and stress associated with such a sport – nearly one-third of these

Hyperextended Wrist

affect the hand and upper extremity.  Despite the best equipment and preventive measures, the jarring vibration of a rough terrain, handlebar hand positioning for hours at a time or tense ride into the wind can result in such repetitive stress conditions as carpal tunnel syndrome or handlebar palsy (also known as ulnar neuropathy).  Cold weather also makes tissue more distensible and may slightly increase risk for carpal tunnel syndrome as well.

Carpal Tunnel Syndrome

Hyper Flexion of Wrist

One of the most common tendinopathic conditions associated with overuse activity and repetitive stress in the hand and wrist is Carpal Tunnel Syndrome (CTS).  CTS is the result of irritation and swelling, which causes compression within the narrow carpal tunnel located at the wrist – through which one of the major nerves in the arm, the median nerve, passes. CTS is one of the most common overuse hand and wrist conditions affecting cyclists. When the median nerve becomes irritated in this inflamed and compressed tunnel, numbness, pain, tingling and weakness may result in the thumb, index and middle fingers – causing discomfort and affecting a cyclist’s ability to even shift gears with the affected hand.  Resting periodically and stretching the hands, changing grip to reduce hyperextension and hyper flexion may help during the ride, but ongoing pain may require treatment – which is generally nonsurgical and may entail night bracing and/or injection therapy.  CTS pain remaining unresolved following nonsurgical treatment may require a minimally invasive Endoscopic Carpal Tunnel Release.

Handlebar Palsy (Ulnar Neuropathy)
Handlebar palsy, known medically as ulnar neuropathy, is another common overuse or repetitive stress condition affecting cyclists.  It is the result of direct pressure placed on the ulnar nerve at the hand and wrist – from the grip of a cyclist’s hands on handlebars, causing stretching or hyperextension of the nerve.  The ulnar nerve controls sensation in the ring and little fingers as well as the muscular function of the hand.  Compression of it may result in numbness and tingling in the ring and little fingers and/or hand weakness. Nonsurgical treatment such as rest, stretching exercises, and anti-inflammatory medications can generally resolve this condition.

These overuse, repetitive stress conditions affecting bicyclists also often affect motorcyclists – as the continuous vibration of the motorcycle causes the same type of conditions long rides and regular bicycling can cause.

Reducing Your Risks
Decades of cycling enthusiasts have contributed to an array of preventive cycling gear and recommendations for reducing a fellow cyclist’s risk for such conditions.  These include everything from basic and specialized gel cycling gloves to additional handlebar padding and adjustments in handlebar height and overall bike fit specific to each rider.

Applying less pressure or weight to the handlebars and avoiding hyperextension and hyper flexion, along with frequent adjustments to grip and position on the handlebars, should reduce risk for carpal tunnel syndrome and handlebar palsy.

Figures source:  http://www.hughston.com/hha/a_15_3_2.htm

 

 

 

FIREARM INJURIES -When Things Get Out of Hand

While firearm injuries to the hand and upper extremity represent a small percentage of all firearm traumas, when they happen the injury is often severe.

Frequently the result of mishandling a gun, the damage that both a bullet, the chamber and even the recoil can pose to the small bones and joints of the hand and wrist can be devastating and have a longterm impact.

Scope of Hand & Upper Extremity Problems in Firearm Users Range from Trauma to Repetitive Stress Conditions

From partial limb loss to stress fractures and repetitive stress conditions historically diagnosed in those working in a daily repetitive task, firearm users should recognize the dangers that exist behind the barrel as well.

Trauma – Open Wound

A broadly distributed article on an unfortunate handgun user losing the top half of his ill placed thumb – a result of the powerful vapors escaping from the chamber upon firing – cast a spotlight on the dangers of using certain firearms and the magnitude of damage that can occur to the small bones and intricate network of nerves, tendons and ligaments of the hand.

While this type of injury is uncommon, it is important to know what to do should it happen. Collecting any remains separated from the impacted area could aide a hand surgeon with replantation.  Rinsing the wound with sterile, normal saline and wrapping it if possible is advised just before heading to an emergency center for immediate assistance.

The surgical approach depends on the severity of damage to the tissue and bone. Open wounds like this are always treated with antibiotics, as “skin” is the body’s largest organ and when its protective barrier is compromised in this way and vulnerable to bacteria, antibiotics are used to reduce risk of infection.   If there is damage to the bone, surgery would entail stabilizing the bone.  Then, the tendons are repaired and the blood flow is re-established – with repair of the artery and veins. Potential problems can result from the magnitude of the blast, confounded by the risk of infection.  The expected outcome and long term function of such an injury is often highly variable as it depends on the amount of tissue damage from the accident.  Often times patients are able to regain adequate function despite not having full mobility of the injured extremity during their recovery.

Forceful Impact – Stress Fractures

Sportsmen frequently using what are known as “big-bore” handguns (models with rifle-type cartridges) have increasingly reported problems with their shooting hand – pain, swelling, weakness when shooting – following periods of preparation/practice for an upcoming hunt. This type of pain can stem from damage to the carpal bones of the wrist, as well as the forearm and elbow as a result of the repetitious and harsh recoil impact (much like a worker regularly using a Jackhammer or other such high powered equipment).  In some cases, this can result in a stress fracture.  Stress fractures are most commonly seen in the lower extremity of frequent runners or athletes, but can occasionally occur in the hand and upper extremity when subjected repeatedly to unusual force.

Treatment of stress fractures generally entails rest from the activity and possibly bracing.  Rehabilitative exercises are also effective in strengthening the shooting arm for both overcoming fatigue and reducing risk for more serious damage.

Repetitive Stress Conditions

Conditions like carpal tunnel syndrome and tennis elbow are considered repetitive stress conditions, most often associated with repetitive tasks in work or sports.  They are occasionally seen in the avid sportsman – practicing to perfect their shooting prior to a hunting season or holding the firearm only certain times of the year in a way to which the hand/arm is not accustomed.

These conditions are most often treated nonsurgically with rest and anti inflammatory medication.  Rehabilitation therapy is also frequently used to address these conditions – to restrengthen, stimulate healing and in some cases retrain hand and arm position during tasks identified as triggers. A new procedure known as the Graston Technique® is also an effective therapeutic way to address these types of repetitive stress conditions.  It entails uniquely designed stainless steel instruments and specially trained hand therapists to detect and treat the affected areas of soft tissue irritation.

Long-term Impact

Persistent pain and chronic inflammation can alter the natural mechanics of the affected limb, negatively impacting joints and accelerating joint degeneration – which could eventually result in osteoarthritis if unaddressed.

Reducing Risks

The best way to reduce the risk of firearm or other activity-related hand and upper extremity conditions is to space practices so that adequate time is allowed to rest the “master” hand and arm.  Strengthening exercises will also allow muscles to protect the soft tissue and bones.  Most sports also have protective gear, developed to address some of the most common conditions associated with frequent involvement.  Hunting is no exception, with brakes, grips and shooting gloves designed to reduce the impact of frequent shooting on the hand, wrist and elbow.

When pain is persistent, seeking medical attention will often reduce risk of more serious injury and permit conservative treatment to effectively address the problem and promote a healthier approach to the activities you enjoy.

 

 

Summer Sideliners

Common summer injuries of the hand, wrist and elbow

As we hike, bike, raft and climb our way through summer adventure, mishaps are bound to happen.  Some of the most common we see include wrist fractures, tennis elbow syndrome and cuts and lacerations to the hand.

Recognizing and treating mishaps that may occur while maximizing these brief few summer months can make a difference in how ready we are for all that awaits us in the fall.

Wrist Fractures

The wrist is susceptible to injury, often used as a first line of defense to break a fall, shield us from impact and soften a blow.  The wrist is comprised of eight small carpal bones, two forearm bones (radius and ulna) and four articulations or joints – which allow the wrist to bend and straighten, move from side-to-side and twist with a broad range of motion.  A force to the hand and wrist may result in a fracture of any one or several of these bones.  While a fracture to one of the smaller carpal bones may only be visible on x-ray, more common distal radius fractures are usually evident – crooked or deformed in appearance.  A wrist fracture may cause pain and swelling and should be immediately addressed.

Tennis Elbow Syndrome (Lateral Epicondylitis)

Though named for the sport frequently causing the condition in tennis players, Tennis Elbow Syndrome is in fact most often caused by everyday activity and diagnosed in those who have never played tennis.  Affecting the outside (lateral) portion of the elbow, tennis elbow syndrome is considered an “overuse” condition.  It is the result of strain placed on the muscles and tendons that attach to the bone.  Also caused by trauma, tennis elbow syndrome can cause pain with gripping, lifting and grasping.

Cuts and Lacerations

Cuts and lacerations to the hand are very common during the summer months as our hands are integral in most outdoor activity and projects. Tendon lacerations are also often the result of trauma to the hand or fingers.  Tendon lacerations may affect either the flexor or extensor tendons.  These types of lacerations often also result in other deep structure damage and require surgical repair.  The cut ends of a tendon must be brought back together in order for the cells inside the tendon to begin the healing/repair process.  Preventing infection in an open wound is also a primary concern with these types of injuries.

 

Platelet Rich Plasma Procedure, Among the Latest in Less Invasive Hand & Upper Extremity Treatment Options

While research efforts continue to assess the benefits of platelet-rich plasma (PRP) in the treatment of some orthopedic injuries and conditions, the clinical results for many, including some high-profile athletes such as Tiger Woods and Pittsburgh Steelers, Troy Polamalu and Hines Ward, are proving favorable.

PRP therapy is thought to accelerate healing by using the patient’s own “platelet rich plasma” and growth factors.  A small amount of a patient’s blood is taken and rotated in a centrifuge to separate red blood cells from platelets.  The concentrated platelets are then re-injected into the affected area – releasing growth factors that are believed to help the tissue recover more quickly.  The procedure is performed on elbows, shoulders, knees, hips and feet.

Initially PRP therapy was used to help athletes recover more quickly from an injury, accelerating recovery of arthroscopic cartilage and ligament repair.  Today, PRP injection therapy is used for some chronic tennis elbow and golfer’s elbow cases, as well as other cases of tendinitis.  The growth factors and stem cells that concentrated levels of the patient’s platelets activate not only promote more rapid healing but are also found to reduce pain and osteoarthritic symptoms and inflammation.

Tennis Elbow and Golfer’s Elbow

“Overuse conditions” affecting the muscles and tendons of the forearm where they attach at the outside of the elbow, tennis elbow (also known as lateral epicondylitis), or inside of the elbow and forearm as in golfer’s elbow (medial epicondylitis), are generally first addressed with conservative treatment – rest/activity modification, bracing, non steroidal anti inflammatory medication (NSAIDs).  Traditionally, patients continuing to suffer from chronic tennis elbow despite conservative treatment are recommended for surgery to address the affected tendons.  While arthroscopy has made surgical intervention less invasive, PRP therapy offers a non surgical option for chronic tennis elbow sufferers – providing relief for the pain and tenderness associated with the condition.

The Procedure

PRP therapy is a simple in office procedure and does not require a separate visit.  Patients opting for the therapy simply request it during their examination.  Results are usually evident within just a few days.

 

 

Unexpected… Pregnancy Related Hand & Wrist Problems, Part 3 (Trigger Finger)

This is the last part of a three-part series on unexpected hand and wrist conditions experienced during pregnancy.  We have focused in this series on three of the most common conditions expectant moms may experience, Carpal Tunnel Syndrome, de Quervain’s Tendonitis and Trigger Finger.

Last month we discussed deQuervain’s Tendonitis and the non invasive ways in which we address the condition – and prior to that Carpal Tunnel Syndrome.  In this last part of the series, we focus on Trigger Finger.

Any one of these conditions may be prompted in expectant moms as a result of the hormonal changes, increased blood flow and water retention and swelling in the body during pregnancy.

Trigger Finger is a disorder characterized by snapping and locking of the flexor tendon of the affected finger or thumb. The term Trigger Finger comes from the unlocking of the finger, in which case it pops back suddenly as if releasing a trigger.

Trigger Finger is the result of inflammation of tendons connecting muscles of the forearm to the finger and thumb bones.  This connection permits movement and bending. While in most cases the inflammation is the result of a repetitive or forceful use of the finger or thumb, medical conditions causing a change in tissues – such as pregnancy – may also prompt Trigger Finger.

One of the early symptoms of Trigger Finger is soreness at the base of the finger or thumb, followed by painful clicking or snapping when flexing or extending the affected finger.  Occasionally there may be swelling.  Periods of inactivity may make this worse, though eases with movement.  In more severe cases, the affected finger or thumb may lock in a flexed or extended position – and forced to straighten.  Joint stiffening may eventually occur.

Diagnosing and Treating Trigger Finger

Diagnosing Trigger Finger is done with a physical examination of the hand and assessment of the symptoms.

Treatment for Trigger Finger is generally conservative and may include:

  • Avoiding activity that aggravates the affected finger or thumb
  • Anti-inflammatory medication
  • A steroid injection into the tendon sheath

If conservative treatment is unable to resolve the condition, a minimally invasive surgical procedure to release the tendon sheath may be indicated.  Expectant women are advised to wait before considering surgical treatment as often times the condition is resolved following pregnancy – when the body resumes normal function.

Unexpected… Pregnancy Related Hand & Wrist Problems, Part 2

Last month we discussed several unexpected hand and wrist conditions associated with pregnancy – the first in a series of blogs on this subject.

We focused first on one of the most common pregnancy related hand and wrist conditions, Carpal Tunnel Syndrome – discussing the symptoms and common treatment options available to expectant moms.Pregnancy related hand conditions

This month we’re discussing another common hand and wrist condition women may experience during pregnancy and following childbirth, deQuervain’s Tendonitis.  Like Carpal Tunnel Syndrome, deQuervain’s can develop as a result of the musculoskeletal changes, hormonal fluctuations, pregnancy related fluid retention and nursing – all of which can place stresses on the tendons.

DeQuervain’s Tendonitis affects the tendons around the base of the thumb and results when these tendons become irritated – causing the lining around the tendon, known as synovium, to become inflamed.  Tendonitis actually means “swelling of the tendons.”  Tendons are responsible for attaching muscle to bone.

The main symptom of deQuervain’s Tendonitis is pain and tenderness along the thumb side of the wrist, which may radiate down the thumb or up the forearm when rotating the wrist, grasping things or gripping.  The swelling may also place pressure on nearby nerves, causing numbness in the thumb and index finger.  The pain may be gradual or arise suddenly.

DeQuervain’s Tendonitis is generally easily diagnosed in the physicians office after a physical examination and discussion of patient history.  Patients are then asked to perform a series of hand movements and discuss the level of discomfort and area of pain and tenderness.Parts of the hand and wrist affected by deQuervain's Tendonitis

Treating deQuervain’s Tendonitis
Treatment for deQuervain’s Tendonitis is generally nonsurgical and may include:

  • Resting the thumb and wrist with the support of a splint
  • Anti-inflammatory medication 
  • A steroid injection into the tendon compartment
Look for the final part of this series on Unexpected Pregnancy Related Hand & Wrist problems next month when we talk about Trigger Finger.

Unexpected… Pregnancy Related Hand & Wrist Problems

Pregnancy, while one of the most exciting times of a woman’s life, can also present a few physical challenges – affecting parts of the body new moms-to-be may not expect.

During pregnancy women are not only adjusting to changes in the body necessary to create new life, but also other less expected changes resulting from the musculoskeletal challenges and overall physical demands pregnancy places on body function.  These demands come from added weight of carrying the baby as well as the reallocation of nutrients from mom to baby, hormonal changes and pregnancy-related fluid retention.  

It is this type of physical impact to seemingly unrelated areas of the body like the hands, wrist and elbow that takes most expectant women by surprise.

While problems in these areas might be expected after the baby is born – as extended holding in unusual positions, feeding positions, pushing of strollers and other unusual hand and upper extremity movements place stress on the hands, wrist and elbow – there are actually a number of hand and upper extremity pregnancy-related conditions women may experience.

Such conditions include carpal tunnel syndrome, deQuervain’s tendonitis, trigger finger and general swelling and tingling in the hands and upper extremity.

This article is one in a series focusing on pregnancy related conditions, beginning with carpal tunnel syndrome, as it is one of the most common hand and wrist conditions affecting pregnant women.  While often categorized as a “repetitive stress” condition – which affects those performing a repetitive tasks resulting in irritation and inflammation – it is often also commonly associated with pregnancy.

Carpal Tunnel Syndrome

Carpal tunnel syndrome is the compression of the median nerve passing through the narrow carpal tunnel of the wrist.  Increased fluid generated during pregnancy can cause the same inflammatory/compressive effect of repetitive stress generally associated with carpal tunnel syndrome. 

Carpal tunnel syndrome is most often experienced in the third trimester when fluid retention is at its highest.

Symptoms of carpal tunnel syndrome may include pain, tingling and numbness in one or both hands. It is traditionally addressed nonsurgically with behavior modification, rehabilitation exercises and bracing.  If bracing and activity modification do not alleviate the problem, a steroid injection may be given and usually resolves the problem within a day or two.  Patients infrequently will need surgery if the carpal tunnel syndrome is related to pregnancy.