Follow Up Case Study -- Ultrasound Guided Injections Offer Immediate and Lasting Relief for New Moms

Many new mothers suffer from chronic wrist pain caused by the unaccustomed awkward hand positions required to hold and care for an infant. Injections can offer immediate and lasting relief.
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This is a follow up to my last posting about how ultrasound is being used for more than imaging of a pregnant woman and how a busy mom discovered that an ultrasound guided injection could relieve her from chronic wrist pain.

Many new mothers suffer from chronic wrist pain caused by the unaccustomed awkward hand positions required to hold and care for an infant. The pain usually occurs when forming a fist, grasping objects or turning their hand and wrist and is sometimes referred to as new mom's syndrome. The condition, which is medically known as De Quervain's tendonitis, can be so severe that it hinders the simplest of daily required tasks, such as bathing, feeding or changing the newborn.

Lisa Fleury, of Northvale, N. J., a working mother with three children under the age of seven, was all too familiar with this condition. She began experiencing a sharp pain in her right wrist and thumb almost immediately following the birth of her third child. After visiting with a local orthopedist, she was diagnosed with De Quervain's tendonitis, prescribed an anti-inflammatory medication and advised to purchase a wrist brace.

Neither of these treatment options provided adequate relief, so Lisa was referred to an occupational therapist and fitted with a custom-made brace. While using the new brace, Lisa's right hand was adequately protected so that she was able to achieve some pain relief, but she then had to rely on her left hand to accomplish most of her daily tasks. Although the brace seemed to help, the reallocation of hand usage ultimately shifted the problem to her left hand so that Lisa was back where she started, in pain, very frustrated and still without the use of her dominant right hand.

De Quervain's tendonitis is caused by repetitive strain injury and is difficult to control and recover from. It is very often seen in new moms because they hyperextend the thumb when holding their baby's head. The condition is likely to keep coming back if care is not taken to continually maintain the muscles and tendons.

Lisa's commentary on the condition included, "It is almost impossible to watch three kids when you are in agony with one hand and you have to take the brace off every time you are tending to your child or typing or cooking. Basically, you have to take the brace off all of the time, which, I am sure, was not helping my problem. The doctor told me to rest my hand, but that is virtually impossible for a mom with three kids. Another six months of being a one-handed mother in constant pain was not an option. Something needed to be done."

Fortunately for Lisa, a friend told her about the use of ultrasound to guide medication injections to treat conditions such as new mom's syndrome. Lisa consulted with her orthopedist who referred her to Hospital for Special Surgery, Department of Radiology and Imaging ultrasound specialist, Dr. Ronald Adler.

The ultrasound procedure used by Dr. Adler allows radiologists to obtain a clear visualization of the tendons so that medication can be accurately injected into the affected area. This "precision" treatment option appealed to Lisa, as the likelihood of success would be much higher than if a "blind" (without imaging-guidance) injection was performed, as medications could erroneously be delivered to the wrong area. Additionally, ultrasound would not expose her to radiation inherent in most other imaging technologies.

According to Dr. Adler, "In the case of De Quervain's, the tendons are situated in close proximity to the radial artery and nerve, which makes it difficult to accurately position the needle, particularly when it is done as a blind procedure. Using ultrasound, we can pinpoint the tendon and ensure that the medication is being injected into the exact location. In the majority of cases, patients experience immediate relief and after a few days their pain often subsides completely."

"The idea of knowing that the doctor could actually see where the medication was going made me much more confident," said Lisa. "I even got to watch the entire procedure on the screen, which amazed me since needles have always made me a little nervous. Dr. Adler was incredible, and he explained everything to me step by step. The entire process went very quickly and I was feeling better and in and out of there in less than hour. This was a miracle cure. I wish I had known about it sooner."

Pain over the thumb side of the wrist is the main symptom of De Quervain's tendonitis. The pain may appear either gradually or suddenly and be felt in the wrist; in some cases, the pain may radiate up the arm. The symptoms usually progress with use of the hand and thumb, especially when forcefully grasping things or twisting the wrist.

Here are some tips for preventing De Quervain's tendonitis:

  • Purchase and consistently use a nursing or "breast friend" pillow, with a velcro waist band, which supports the child and takes excess weight off the wrist.
  • Enroll in a postpartum exercise class to help strengthen arms and shoulders.
  • Practice holding your hands and wrists in a flat line, not at an angle, with the thumb pulled into the palm, not cocked. Try this when holding or carrying a baby, pushing a stroller, etc.

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