Ultrasound Guided Injections Offer Immediate and Lasting Relief for New Moms with Chronic Wrist Pain

Busy mom describes the treatment as a “miracle cure”

New York, NY—May 2, 2006 

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

Lisa Fleury, of Northvale, N.J., a 35-year-old 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 right back where started – in pain, very frustrated and still without the use of her dominant right hand.

“De Quervain’s tendonitis is a difficult, repetitive strain injury to control and recover from,” said radiologist Dr. Ronald Adler, chief, Division of Ultrasound and Body CT, Hospital for Special Surgery (HSS). “We see it very often in new moms because they hyperextend their thumbs when holding their baby’s head. It is likely to keep coming back if care is not taken to continually maintain the good condition of muscles and tendons.”

“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,” Lisa lamented. “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,” said Lisa. 

Fortunately for Lisa, a friend told her about the use of ultrasound to guide injections of medication to treat conditions such as new mom’s syndrome. Lisa consulted with her orthopedist who referred her to HSS radiologist and ultrasound specialist Dr. Ronald Adler. 

The procedure allows radiologists to obtain a clear visualization of the affected tendons so that medications 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 “blind” (without imaging-guidance) injections were used, as medications could erroneously be delivered to the wrong area. Additionally, ultrasound would not expose her to radiation inherent in other imaging technologies.

“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,” noted Dr. Adler. “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 an hour. This was a miracle cure. I wish I had known about it sooner.”

Signs and symptoms of De Quervain’s tendonitis
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.

Tips for preventing De Quervain’s tendonitis
Recommendations for avoiding new mom’s syndrome include:

  • Purchase and consistently use a nursing or "Breast friend" pillow, with a velcro waistband. This pillow will support the child without slipping out from underneath him/her and take excess weight off of 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.

For more information on Hospital for Special Surgery Department of Radiology and Imaging and Dr. Ronald Adler, visit http://imaging.hss.edu/.

About Hospital for Special Surgery Department of Radiology and Imaging
Hospital for Special Surgery (HSS) Department of Radiology and Imaging, under the direction of Radiologist-in-Chief Helene Pavlov, M.D., FACR, has the largest and most experienced academic musculoskeletal radiology faculty in the world, each with academic appointments at Weill Medical College of Cornell University. The department's focus is on both the imaging diagnosis of musculoskeletal conditions/diseases and the treatment of specific conditions utilizing image guidance. More than 180,000 musculoskeletal examinations are performed annually, including: magnetic resonance imaging (MRI), computed tomography (CT), ultrasound (US) and nuclear medicine (NM) in addition to conventional radiography (X-ray). The department also offers teleradiology services. All HSS radiologists are Board Certified by the American College of Radiology and have received numerous awards by honor and professional societies, including the Consumer's Research Council of America Guide to America's Top Radiologists.

About Hospital for Special Surgery
Founded in 1863, Hospital for Special Surgery (HSS) is a world leader in orthopedics, rheumatology and rehabilitation. HSS is nationally ranked No. 1 in orthopedics, No. 3 in rheumatology by U.S. News & World Report (2007), and has received Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center. In the 2006 edition of HealthGrades' Hospital Quality in America Study, HSS received five-star ratings for clinical excellence in its specialties. A member of the NewYork-Presbyterian Healthcare System and an affiliate of Weill Medical College of Cornell University, HSS provides orthopedic and rheumatologic patient care at NewYork-Presbyterian Hospital at New York Weill Cornell Medical Center. All Hospital for Special Surgery medical staff are on the faculty of Weill Medical College of Cornell University. The hospital's research division is internationally recognized as a leader in the investigation of musculoskeletal and autoimmune diseases. Hospital for Special Surgery is located in New York City and online at www.hss.edu.

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