Saturday, May 4, 2013

Mommy Wrist



Something about the having a baby is just beautiful, ask any mom.  Then there's the fragmented sleep, weight gain, transition back to running a house and working......and wrist problems.  Carpal Tunnel has been so published/talked about in the last 20 years that anyone will be able to figure out if their symptoms are similar and find conservative treatment to start online. 

I had a patient come in referred by ob/gyn.  Second time around mom with wrist pain that was "different".  Started about 6th week after leaving the birthing center and has been persistent since.  Mom is now 3 months out and suffering.   Tried to use the brace from walgreens for carpal tunnel with no help.  Pain grabs her with certain movements and now is interfering with sleep.  No history of this before and no trauma.  Still breast feeding but planning to wean off and return to work in about a month.  (Incentive to get the wrist pain resolved since she uses a computer 8 hours a day)

There are a few things I watch out for in anyone complaining about joint pain.  First is always broken bone or tumor.  Luckily with the wrist, small joint, easy to evaluate.  Then I think in mechanical terms and locate the area of pain/dysfunction.  Finally look above, below and referred.  In rare cases the pain will come from soft tissue like infection, other tissue, blood vessel or metabolic problems.  If I can't find a good solution or patient has tried everything, time to add traditional chinese medicine  and break out the needles to "move stuck energy" until conventional modalities start to work. 

If the pain is evaluated early, usually history gives the diagnosis (physical exam and testing backs up the dx).  If the pain has been "lived with" for a long time, the presentation can be different as the average person will compensate and may not remember the new symptoms vs the old symptoms.  Detective work ensues (experience and listening) and chipping away at confusing red herrings starts until the true problem reveals itself.

In this case, I ruled out scaphoid fracture (very important bone in the wrist that if ignored, leads to chronic disability) and went straight for the gusto-finkelsteins test.  BINGO! reproduced pain exactly.  This is notorius for moms as they reach to pick up 3-4month old (baby has good head stability by then) and lift up play face to face.  Gave a specific splint for thumb immobilization, advil (only antiinflammatory ok with breast feeding moms).  Also suggested facilitating healing with diet control (no dairy or wheat), turmeric and magnesium (ok with baby) topical treatment (helicrysium, tea tree, traumeel, ice massage) and acupuncture as back up if not better in 3 weeks.   If all else fails, steroid injection into the sheath of the tendon will help, and shouldnt effect breast mild production.  By then occupational/physical therapy will problably be necessary. 

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