Problems encountered
- CMC and dequervains
- Wrist and distal forearm
- Neck and elbow radial tunnel pain
- Neck / lacertus / CTS
- Fingers and trigger
- Other body parts feet, lower back hips
Dominance- left
Involved side – left
Pregnancy – no gestational diabetes
Just high blood pressure
36 weeks delivery via cesarean healthy twins weighing 5.9 and 4.11 lbs
She lost weight after delivery to 124, before pregnancy her weight was 134+\- lbs
She had only gained 15 lbs during the pregnancy with the twins. 1st delivery and only these twins no other deliveries.
CMC Joint
Prior level: Some CMC discomfort especially at night after a long days work
She would wear splints on an off and removed the hard / soft brace when treating patients but put it back on after the treatment was done.
No elbow pain or sensory complaints in the median distribution prior to deliver
Some neck pain/ migraines secondary to history of whiplash injuries
CMC joint (less than a year after delivery)
Symptoms– sharp pain with pinching and a popping sensation
Even a simple sheet pulling at night would elicit a sharp pain and wake her up
If that persisted then the pain would radiate up the forearm giving dequervains symptoms
She was told it must be mommy’s thumb (deQuervains) but it was the CMC that triggered the pain.
Treatment
If she popped the CMC joint right away back in the socket the radiating pain would go away fairly quickly however if she waited then the Dequervains symptoms persisted.
The way I managed her Dequervains was pulling on my intersection area ulnarly while performing Finkelstein maneuver pain free and a few reps later the symptoms would disappear, then I taped the intersection area pulling the tendons ulnarly with leuko taping that maintained the relief
She then started to wear the comfort cool splint (forearm based) to maintain the CMC joint in position which maintained pain free motion and allowed me to work.
The pregnancy happened during pandemic so she had started using gloves for treatment and so later when the symptoms exacerbated after delivery she wore the gloves with the braces
She placed gloves on top of the brace and functioned without any discomfort day or night.
She continued wearing the forearm brace especially at work for 2 + years and then transitioned to a hand based comfort cool at work
At home we recommended that she wear Hely Webber Titan thumb spica when lifting kids to avoid any Dequervains symptoms. I found it convenient as she could slip my hand into it and pick her kids up at night or any time in the day and didn’t always have to wear it, it was just worn for prevention of Dequervains symptoms . She had a forearm based thumb spica fabricated by one of my therapists but she couldn’t wear it with kids as she found it to be too rigid when dealing with kids.
She does her CMC stabilization exercises and now if her CMC joint aches she still have to pop it (she was taught how to perform that) back in place. I do like the chip clip especially this one Click here as it gets further into the webspace and helps provide as gentle distraction between the 1st and 2nd MC, plus it has the grip to prevent it from sliding and it tapered just right to fit in the webspace. It helps maintain the webspace.
How I changed my practice
After this experience with the therapist for dequervains, I do not fabricate thumb spica for new moms who presented with dequervains and instead offer the titan splint option.
For dequervains: without any postpartum pregnancy I fabricate thumb spica if they don’t have a splint to wear with sleeping and lifting and do Leuko taping with the Finkelstein exercise with intersection pull ulnarly, on an hourly basis
Her Xrays
Before
Video of popping the cmc back in place Click here
Tests that can be performed- for cmc – grind test
Dequervains- Finkelstein
Wrist and distal forearm pain
Symptoms- sharp pain in the dorsal distal forearm deep ache
No tenderness on palpation
Treatment myofascial techniques wouldn’t help even if I gave deep massage
Mobilizing my wrist did the trick
How i changed my practice
When patients complained of pain in the dorsal distal forearm without trauma I looked at the wrist and at the radio carpal joint, if I mobilized it there would be a little click and the pain would then start to subside.
Then the myofascial techniques with extensor stretch help with reducing the pain in the distal forearm.
If pain persisted or would create the same problem then I would tape them up (Mid carpal taping to treat carpal instabilities ) and initiate pain free stabilization exercises with sub maximal effort.
Neck and elbow radial tunnel pain
After her son got hospitalized around 14-15 months of age, she had held him for around 24 hrs taking care of him.
The poor posture with the load on the non dominant arm put a stretch on her nerves causing a traction on her nerves resulting in burning pain down her arm and especially around the radial tunnel.
Parsonage turner syndrome
The arm was heavy with difficulty lifting it up or even carrying a cup let along her twin toddlers.
No tenderness around the radial tunnel but she felt right in the area (deep pain) and felt the need to perform release of the mobile wad.
She was in excruciating pain, My therapists tried to help with myofascial manipulation around the forearm and neck and upper trap
She even got it adjusted by a chiropractor and got postural taping with either Leuko or kinesio tape to provide proprioceptive input.
But it was the combination of that and postural exercises with some yoga moves that provided nerve glide in combination with trunk rotation that did the trick. I taught her to do my version of it that offeres median or radial nerve glides, depending on which nerve was acting up.
Even now she has days when the entire arm gets sensitive especially if she is not careful with her posture, she is taught to do a couple of the yoga moves and it fixes it.
She now doesnt let it flare up, she now wear the upright go 2 which manages the posture.
She is taught exercises for rhomboids in an isotonic, with isometric hold and then eccentrically lowering it down on the ball which is harder but gets the results for her
She worka her middle traps the same way and perform regular upper middle and scalene stretches.
Knuckle pain after pregnancy
She noticed that since her delivery her knuckles ache and she feels the need to pop then especially in the morning
And I wondered why that was the case
I had read about nitrous oxide in the joint but I wondered if that was it but why in the morning
I know there was water retention with pregnancy
I hypothesized that it could be that the laxity from the pregnancy with the water retention have stretched the ligaments permanently and so now with daily activities it results in some amount of swelling due to excessive movement
However due to the movement all day it gets pumped out but but at night that small amounts of swelling persists and results in slight subluxation of the joint (all knuckles) as in the cmc which sits subluxed
So when she wakes up there is some discomfort and until she pop the knuckle and put it back in place the aching continues. Pt was taught to pop the knucles in a way that wouldnt damage the joints.
I sometimes wonder what If she didn’t mobilize the joint would it cause early arthritis
The tightness she felt in the morning if she didnt pop the knuckle or tried to actively make a fist, it would have put more pressure on the tendons as they would have to work harder to make a fist. Popping the knucles and easing the pressure made it easier and pain free when using the hand for daily activities.
Hot water use in the morning / hot shower eased any achyness in the joints making them move easier thus, preventing development of trigger fingers.
Pregnancy ended up with more questions than answers
But I felt like I found more solutions that I could use to help my patients
Clinical reasoning became a big part of helping them solve problem,s I took notes so I could help my patients
I hope following the journey of this therapist would help your patients as well
But I felt like I found more solutions that I could use to help my patients
Clinical reasoning became a big part of helping these post partum patients survive and as I solved problems I took notes so I could help more of my patients
I hope this therapists journey would help your patients as well.