Prenatal Preventative Measures For De Quervain's Tenosynovitis

Editor's note: This text-based course is a transcript of the webinar, Prenatal Preventative Measures for De Quervain's Tenosynovitis, presented by Tina Dimopoulos, OTR/L, OTD, CHT.

Please also use the handout with this text course to supplement the material.

Learning Outcomes

After this course, participants will be able to:

• Describe the anatomical considerations and risk factors specific to De Quervain's Tenosynovitis during the prenatal and postpartum periods
• Explain preventative strategies and ergonomic principles that therapists can apply to reduce strain and promote optimal hand function in expectant and new parents
• Identify key activity modifications that support early intervention and prevention of De Quervain's Tenosynovitis

Introduction

Good afternoon, and thank you so much for joining me today. I am very excited to be speaking to you all on the topic of prenatal preventative measures for De Quervain's Tenosynovitis. Before I begin with anatomical considerations, I want to walk you through the structure of today's presentation so you have a clear sense of where we are headed.

I am going to begin with the anatomy of De Quervain's — where it occurs, which structures are involved, and what the general risk factors are. From there, we will dive into more specifics related to the pregnant and postpartum mother, because the body changes that occur during pregnancy and in the postpartum period create a unique, layered set of risk factors that every clinician working with this population needs to understand. We will then discuss what happens when a new mother develops De Quervain's, as well as the common positions and child-care activities that put new mothers at greatest risk. And by understanding what happens when a new mother has De Quervain's, we will be best able to develop the preventive strategies, education, and clinical approaches we can instruct our clients on. That is what we will conclude with today.

I want to be clear that while this course focuses on mothers as the primary population, the anatomical principles, risk factors, and preventative strategies apply to any primary caregiver engaged in the repetitive demands of infant care. The condition is so closely associated with new mothers that the layman's term "mommy's thumb" has become widely recognized, and that association is exactly what makes this population such an important focus for our preventive efforts as therapists.

I bring both an orthopedic and neurological lens to this topic. I earned my bachelor's, master's, and doctorate in occupational therapy from the University of Southern California, completed my OTD clinical residency in outpatient neurorehabilitation at Rancho Los Amigos National Rehabilitation Center, and became Neuro IFRA-certified. I later earned my Certified Hand Therapy credential in 2021 while working at Mount Sinai Hospital in New York City. By pursuing specialty areas in both orthopedics and neurology, I bring a comprehensive and robust approach to outpatient therapy. I currently operate my private practice, Pulse OT, and serve as an adjunct professor. This condition is one I encounter regularly in clinical practice, and I believe therapy practitioners are uniquely positioned to make a meaningful difference in how this population is served — particularly through prevention.

Anatomical Considerations

Basic Definition and Clinical Names

De Quervain's tenosynovitis is defined as a tenosynovitis of the first dorsal compartment — more specifically, it is a stenosing tenosynovitis of the extensor compartment of the thumb. On the radial aspect of the hand, there are two tendons that cross under the extensor retinaculum. These tendons are the extensor pollicis brevis (EPB) and the abductor pollicis longus (APL). This region is known as the first dorsal compartment, also referred to as the first extensor compartment.

In the clinical space, I most commonly see this condition referred to as De Quervain's Tenosynovitis, though you may also encounter De Quervain's tendonitis, tendinosis, or tendinopathy. You may also see it documented as De Quervain's disease or syndrome, or as radial styloid tenosynovitis. In layman's terms, the most common name by far is mommy's thumb — and that is one of the primary reasons we are having this course today, to really talk about why this condition carries that name. It may also be called mommy's wrist or new mom syndrome. Other populations at high risk include gamers, who give rise to the term gamer's thumb, as well as individuals with heavy cell phone use, who give rise to texting thumb due to the repetitive thumb movements required to send text messages or scroll on a phone (Hospital for Special Surgery, 2025).

What Is Happening in the First Dorsal Compartment

The tendons of the first dorsal compartment are extrinsic — meaning they start outside of the hand, in the forearm, cross the wrist joint, and then insert into the thumb. When you look at an anatomical image of the region, you see an inflamed tendon, a swollen synovium, and a thickened tendon sheath. That image shows exactly where, anatomically, the region of pain is for your client.

What happens in De Quervain's is that there is a thickening of the tendon sheath at the extensor retinaculum, and this thickening impacts the smooth glide of the tendons. Clients may describe a popping sensation with wrist and thumb movement, sometimes described as a stop-and-go sensation in the region of the first dorsal compartment. The main clinical complaint is pain and, on palpation, sometimes swelling over the radial styloid. There will also be tenderness in the area of the first dorsal compartment — if you were to palpate over these inflamed tendons, there might be swelling and pain to touch (Anderson et al., 2012; Hospital for Special Surgery, 2025).

De Quervain's tenosynovitis typically occurs from repetitive low-grade trauma to the wrist and thumb. We know that new mothers engage in a great deal of repetitive motion in their childcare tasks, which is why this population is at significant risk due to the volume of repetition in their daily caregiving duties. It is not to say that De Quervain's cannot develop from a blunt trauma to the area, but it is most commonly seen from repetitive low-grade trauma to the first dorsal compartment.

On ultrasound imaging, typical findings include synovial thickening and fluid within the tendon sheath. I am flagging the fluid component intentionally here because, in the section on pregnancy-related risk factors, we will return to the topic of fluid retention and its particular relevance to this population. Imaging may also reveal tendon thickening and increased blood flow to the synovial lining of the tendon sheath (Chong et al., 2024). Synovial thickening, tendon thickening, inflammation, and fluid retention can all lead to that popping or stop-and-go sensation with movement, ultimately impacting the smooth glide of the tendons that make up the first dorsal compartment. Because the first dorsal compartment is a small and confined area of the body, if any thickened tissue or tendon sheath is present, or if there is increased fluid, there is less room for the gliding mechanism to occur smoothly; therefore, that friction and stop-and-go sensation with attempted movement can occur.

Movements, Provocative Tests, and Functional Limitations

The movements most commonly associated with pain in clients with De Quervain's tenosynovitis are wrist deviation, typically ulnar deviation combined with wrist flexion, and thumb abduction, that wide thumb position. The most commonly used provocative tests are Finkelstein's test and Brunelli's test (Anderson et al., 2012).

The functional limitations associated with De Quervain's involve tasks requiring wrist deviation and thumb abduction. Many clinicians associate mommy's thumb primarily with lifting and carrying an infant, using a wide-thumb approach, typically under the infant's axillary region. However, carrying an infant is not the only action that can trigger De Quervain's or place clients at risk. It also arises from repetitive wrist and thumb movements to load and unload groceries, type or text, write, and open a doorknob or a jar. All of these can be aggravating or bothersome for clients with this condition (Anderson et al., 2012).

Prenatal and Postnatal Implications

To best understand the prenatal approaches we will discuss later, clinicians must first understand the specific pregnancy and postpartum implications and body changes affecting this population. There are several categories of change occurring simultaneously. One is the psychological impact. The mother's body is going through a significant transformation as she transitions from pregnancy to delivering a newborn, with accompanying changes in roles, routines, and everyday life. There are also musculoskeletal changes that happen innately as the body prepares for delivery, hormonal changes that we will discuss in more detail, edema and fluid retention, most typically seen in the third trimester, and weight gain. As the baby grows in the third trimester and prepares for delivery, the center of gravity shifts, which can change biomechanical demands, ultimately placing more stress on distal joints or altering the mother's typical posture. There are also bone and soft tissue changes at the cellular level, with joints becoming more lax and different cellular changes placing the new mother at increased risk for musculoskeletal conditions (Smith et al., 2025).

Causes

Generally speaking, potential causes of De Quervain's Tenosynovitis include participation in any activity or sport that stresses the hand and wrist or requires repetitive movement, and many caregiving activities new mothers engage in fall under that category. Another potential cause is rheumatoid arthritis. A direct injury to the area of the first dorsal compartment is also a potential cause, though not as commonly seen. And then there is fluid retention from pregnancy, which I am noting again intentionally to link to the anatomical discussion above (Hospital for Special Surgery, 2025; Mayo Foundation for Medical Education and Research, 2022).

Outside of child-rearing tasks, other activities that can involve aggravating movements of the hand and wrist include racket sports such as golf or tennis, computer use or texting, knitting, and opening doorknobs and jars.

Risk Factors

General Risk Factors

The general risk factors for De Quervain's Tenosynovitis include participation in any activity, job, or sport that stresses the hand and causes repetitive hand and wrist movement. Typically, the condition is acquired from that low-grade repetitive movement or resistance applied to the first dorsal compartment. It is commonly seen in individuals aged 30 to 50, is more common in women, and is associated with pregnancy and child-rearing (Mayo Foundation for Medical Education and Research, 2022).

Pregnancy-Related Risk Factors

De Quervain's Tenosynovitis is the second most common hand and wrist disorder during pregnancy. Carpal tunnel syndrome is the most common, with De Quervain's a close second. In the prenatal and postpartum population, De Quervain's disease is most common during the third trimester, when weight gain is at its highest, fluid retention is most pronounced, and hormonal changes of pregnancy are most significant. Bilateral symptoms are more common in this population than in the general population. It is more commonly seen to have a pregnant or postpartum mother with bilateral De Quervain's as opposed to just one side, which is a distinguishing clinical feature of this population (Smith et al., 2025; Afshar & Tabrizi, 2021).

Joint laxity is another significant risk factor during pregnancy. In general, joints become more lax, and a hormone called relaxin plays a major role. Relaxin can remodel bone, muscle, ligaments, and tendons, ultimately loosening these soft tissues and promoting greater joint laxity. These changes in the body during pregnancy have been associated with increased musculoskeletal pain and an increased likelihood of developing musculoskeletal symptoms.

I came across a compelling study from Stanford University School of Medicine that I want to highlight. This study concluded that pregnancy is a significant risk factor for hand conditions and was associated with increased odds of De Quervain's Tenosynovitis, and that gestational diabetes is a significant risk factor for both carpal tunnel syndrome and De Quervain's. Most strikingly, pregnancy is associated with a five-fold increased odds of De Quervain's, and gestational diabetes was a significant risk factor for both conditions (Smith et al., 2025). I find this clinically very important. When a client comes in with De Quervain's, and she is pregnant or postpartum, asking about gestational diabetes is a meaningful clinical question. The reason gestational diabetes carries such an elevated risk is that elevated blood glucose levels can affect tendon structure, making tendons thicker and stiffer and impacting the gliding mechanism. In the confined space of the first dorsal compartment, any thickened tissue, thickened tendon sheath, or increased fluid leaves less room for smooth gliding, producing that friction and stop-and-go sensation. Diabetes is also associated with increased inflammation and fluid retention. So, on top of the repetitive activities that new mothers are already engaged in, there are actual body-level changes that place mothers with gestational diabetes at even further risk for developing De Quervain's.

Fluid Retention

I want to address fluid retention more fully here because it is a thread that runs through the entire risk picture for this population. Pregnant and lactating women have significantly increased water needs. In the pregnant mother, fluid volume increases by approximately 50%, driven by the need for increased blood volume to deliver nutrients to the baby and for adequate amniotic fluid. For lactating mothers, breast milk is approximately 90% water, so postpartum mothers who are breastfeeding have substantially higher hydration demands, and that increased fluid is present throughout the body. Temperature regulation is another contributor, as fluid helps regulate temperature for both mother and baby while the pregnant mother is still carrying the fetus (Montgomery, 2002).

On the topic of hormonal changes specifically, endocrine production increases during pregnancy, and this further promotes fluid retention. The endocrine system acts as the body's primary control system, and during pregnancy, it can cause more fluid to accumulate, including in the small area of the first dorsal compartment. This fluid retention tends to be most significant in the third trimester (Anderson et al., 2012). So you have endocrine-driven fluid retention adding to the mechanical stress on the thumb and wrist from holding and caring for the baby.

Infant Carrying Position and Historical Context

Most clinicians and members of the general public, when they hear the term mommy's thumb and know it as the layman's term for De Quervain's, associate it with lifting and carrying the baby using that wide, abducted thumb position — lifting the baby from the axillary region, out of the crib, out of the car seat, out of the stroller, up from a play mat. It is also the prolonged carrying of the head and neck of the infant, because at that young age, the infant does not have adequate head, neck, and trunk control to support themselves against gravity. The mother's hand and wrist are therefore required to support the head during breastfeeding or bottle feeding, as well as during many other childcare activities. That position to support the head is often the wide-thumb position with wrist flexion and deviation.

Historically, in the 1960s, De Quervain's was associated with new mothers, and the prevailing explanation at the time was that it was caused by washing and wringing cloth diapers. The repetitive twisting motion of the wrist and thumb required to clean and wash cloth diapers was thought to be a primary cause. That explanation has since been debunked because, in the present day, when cloth diapers are much less commonly used, mothers continue to develop De Quervain's at comparable rates. What has become clear is that the hand and wrist position required to support the baby's head and body creates resistance to the first dorsal compartment. It is that repetitive micro-trauma or stress on the first dorsal compartment that causes inflammation of the synovial sheaths of the tendons in the fibro-osseous tunnel (Anderson et al., 2012).

Baby Size and Developmental Stage

A study by Anderson and colleagues found that the baby's size plays a significant role in the likelihood that the mother will develop De Quervain's. As clinicians, we want to look at the entire picture with our patients, both client-specific and environmental factors. How big is the baby? How long? What is the head circumference? With newborns, there are frequent check-ins and growth measurements, and new mothers often know what percentile their child falls into. Understanding the baby's head circumference, length, or weight helps us, as clinicians, gauge how much resistance the first dorsal compartment may be managing on a daily basis.

This study found that larger and longer babies — those over the 95th percentile — placed the mother at higher risk of developing De Quervain's. The study also found that as the baby's age increased, head, neck, and trunk control improved against gravity, and as the baby began crawling and moving more independently, there was a decreased risk or decreased onset of De Quervain's (Anderson et al., 2012). The developmental stage and the baby's size both play meaningful roles in the mother's clinical risk profile.

Postural and Biomechanical Implications

Risk factors related to biomechanics and posture in the pregnant and postpartum mother are also significant. In the pregnant mother, the center of gravity is changing, additional weight is being carried, and the base of support may be different. These changes in the center of gravity may increase the new mother's risk of relying more on her distal joints than she would if she were not pregnant. The postural adaptations required to accommodate a growing belly can shift how the upper extremities are used, often placing additional demand on the wrist and hand as the proximal trunk and core are less available for load bearing.

In the postpartum mother, having just delivered, there is a weakened core and trunk, and new mothers are typically not cleared to return to exercise for a period of time after delivery. So you have a new mother who is using her hands repetitively for childcare tasks with a weakened core, often pelvic laxity and some instability from having just undergone labor, and who is not yet able to engage in the strengthening activities that would support her posture and proximal stability. This creates a situation where the distal joints, the wrist and hand, are absorbing work that would ideally be shared with the core and larger proximal structures. The postpartum mother is truly working against many compounding factors simultaneously, which aligns directly with why this population is at such high risk for developing this condition. The increased spinal flexion required for many child-rearing tasks also adds to this picture, as forward-flexed postures can increase the stress placed on the distal joints of the upper extremity.

Timeline of De Quervain's Onset

I developed a timeline to illustrate what is happening between the new mother and the baby over approximately 8 months, and I find it very helpful clinically. I suggest starting on the far right of this timeline — at three to eight months — and working backward. Per a 2024 study, three to eight months postpartum was the most common time span for De Quervain's onset (Schulz et al., 2024). That is when most mothers in the study were found to be developing the condition.

Now, working backward from that three-to-eight-month window: developmentally, a newborn typically will not develop adequate head, neck, and trunk control against gravity until approximately four to six months. That means for a significant portion of that highest-risk window, the mother is still providing full manual support for the baby's head and neck during every feeding, every carry, every bath. Moving further left on the timeline to the period immediately after delivery, new mothers are generally not cleared to return to exercise for 6 to 8 weeks, depending on the type of delivery and other factors.

You can see how the window from birth through three to eight months stacks multiple risk factors simultaneously. The mother is not cleared to exercise; she has a weakened core, her posture is impacted, and the baby developmentally cannot yet raise their own head and trunk against gravity. The repetitive nature of childcare tasks across this entire window creates the cumulative low-grade stress that leads to De Quervain's onset. Not only are those distal joints absorbing the weight and repetitive stress, but the core and proximal structures that would normally share that load are compromised as well.

I also want to note that the lactating mother, because of the fluid retention associated with breastfeeding, is at further risk during this period. A study found that once mothers stopped breastfeeding, their likelihood of De Quervain's symptoms persisting decreased (Afshar & Tabrizi, 2021). This is clinically useful information to share with clients. If you are working with a client who is prenatal or postpartum with De Quervain's, useful questions to ask include whether she is breastfeeding or lactating, whether she had gestational diabetes, and whether symptoms are bilateral or unilateral, as all of these are risk factors that can place this population at further risk and help you understand her full clinical picture.

Treatment

From a conservative standpoint, treatment for De Quervain's Tenosynovitis traditionally includes a forearm-based thumb spica splint. The forearm component is important because the muscles of the first dorsal compartment are extrinsic, cross over the wrist, and therefore, we need a forearm-based splint to adequately immobilize the wrist. The first approach would be to use the splint, and, if needed, next a cortisone injection. Non-steroidal anti-inflammatory medications may also be recommended by the physician. Activity modification is addressed throughout treatment to encourage the client to engage in scooping or lifting patterns that do not stress the first dorsal compartment tendons.

Rest is also recommended, but I want to emphasize this point because for the new mother, rest may be extremely difficult to achieve. This may be the time of her life when she has the least rest while being the busiest. She is going to have sleep disruptions and frequent wake windows with the newborn. To ask a new mother to rest, or to completely immobilize one or both hands for a period of time, may seem unachievable. This is precisely why we, as clinicians, want to be preventative, providing education and strategies to our prenatal clients so they are equipped before the baby arrives. Because rest after having the baby might be very difficult to attain.

If conservative measures do not reduce pain and resolve the condition, surgery, specifically a release of the first extensor compartment, may be something the physician and client elect to pursue (Afshar & Tabrizi, 2021).

Regarding questions that may come up in clinical practice: K-tape can be used for De Quervain's treatment, and some clients do experience meaningful pain relief from that approach. As with any modality, you want to consider the onset of the condition and the client's current pain levels when deciding whether taping is appropriate. With exercises, you similarly want to look at the whole picture. Consider when their symptoms began and their current pain levels. There are specific ways to grade exercises. You might start with isometrics, then move to eccentric loading and then concentric movements, or consider proprioceptive wrist exercises, plyometrics, or functional-based movements, depending on where the client is in their recovery. It is worth noting that for the postpartum client, giving them additional tasks to do at home like a home exercise program can be challenging given the demands on their time. Thus, you want to meet them where they are in terms of their condition and their bandwidth. With modalities more broadly, looking at the research and the efficacy of any specific modality, and then checking in with the patient to confirm it is assisting with pain reduction, is a sound clinical approach.

Preventative Prenatal Measures

The Education Gap and Why It Matters

At this point in the course, we have discussed what De Quervain's is, its anatomy, and the symptoms when a client develops the condition. Now let us turn to what we as therapists can do preventatively. Preventative prenatal measures are highly focused on education. It is interesting that many new mothers take educational classes on how to care for their infant. There is a great deal of information available on caring for the baby, but not nearly as much education available on how to care for the mother's body while she is engaging in these new roles. That is a gap, and rehab therapists are well-positioned to fill it.

Many of my clients who are mothers with De Quervain's did not even know about Mommy's Thumb until they received a diagnosis. To me as a clinician, that is a significant gap. If this condition is so prevalent among new mothers, we would hope that they would have this education, know what mommy's thumb is, recognize the early signs, and act on that knowledge to mitigate their risk or at least address their discomfort as soon as possible.

Components of Preventative Education

Education during the prenatal period should cover the signs and symptoms of De Quervain's for early detection, the common childcare areas that pose a high risk of aggravating the first dorsal compartment, and areas outside childcare duties that also pose a risk of aggravation. We also want to recognize that new mothers are not only performing childcare duties but also engaging in other roles, activities, and occupations throughout their day. We want to look at all areas of the individual's life.

We want to educate and train the prenatal mother on strategies, tools, and equipment to help reduce strain on the distal wrist and hand during childcare activities. Often, these are first-time mothers who are still learning which equipment and options are available, so, as clinicians, if we can guide them toward the right choices, that is very beneficial. Education and training on proper body mechanics, instruction in postural exercises, guidance on the use of modalities if pain arises, and orthotic recommendations are all components of a comprehensive preventive program. The goal is to equip our new mothers with to knowledge to best use their bodies, to protect their first dorsal compartment during these childcare roles, and, if they do develop De Quervain's, to recognize it and get it addressed as soon as possible to reduce symptom chronicity.

Goals of the Preventative Program

The goals of a prenatal preventative program are to increase education and awareness for new mothers, to promote engagement in childcare tasks without pain, to encourage participation in maternal roles, to decrease the negative psychosocial impact that can surround child-rearing tasks, and ultimately to improve quality of life (Sheerin et al., 2023).

The psychosocial dimension of this condition is something I want to illustrate through a clinical example. I worked with a client who had bilateral De Quervain's. She was a new mother, and I worked with her from when her son was about six months old through approximately twelve months, on and off throughout that period. She tried to avoid bath time at all costs because bathing was a particularly aggravating childcare task that caused her significant pain. She felt stressed when bath time approached, and it was a maternal role she actively tried to avoid. It had a real negative psychosocial impact on her. Her pain was so intense at times that she told me on a few occasions that she was worried about having a second child because she did not know if she could withstand the pain from De Quervain's again. You can see that these symptoms can have a meaningful impact on quality of life, with more severe effects for some mothers than others. And I believe that we as clinicians can play a significant role in prevention here.

I also want to emphasize the role of education in the bigger clinical picture. Ideally, we can provide education so that our new mothers are set up to know how to best use their bodies, how to protect their first dorsal compartment during these childcare roles, and if they do develop De Quervain's, to know what it is, to get it addressed as soon as possible, and to hopefully decrease the chronicity of the symptoms. Early identification and intervention are always preferable to a more entrenched presentation left unaddressed.

Activity Modifications for New Parents

There are six main areas of childcare tasks that place new mothers at higher risk of aggravating the first dorsal compartment. Let me walk through each one in detail.

Nursing and Bottle Feeding

Mothers who elect to breastfeed experience greater fluid retention, as breast milk is 90% water, and they also need to hydrate more. From an ergonomic standpoint, breastfeeding pillows, or regular pillows to support the baby during bottle feeds, are very important. The head is one of the heaviest parts of the infant's body, and using pillows to support that weight means the mother's hand, wrist, and thumb do not have to bear it during the feeding.

We want to encourage mothers to alternate sides. With breastfeeding, mothers may naturally alternate sides or already have education on this. With bottle feeding in particular, alternating sides is critical because a new mother will typically hold the bottle in her dominant hand and position the baby statically in the non-dominant arm. We would want that switched after certain periods of time to distribute the load. We would also want to monitor wrist and thumb position if there is a prolonged hold on the baby's head or neck, or on the bottle.

There is a variety of baby bottle sizes and widths, as well as grips that can fit over the bottles. As therapists, we want to be aware of the options available and guide our clients accordingly. For mothers who are pumping, we want to avoid static holds of the pump parts. There are attachments to undergarments that can hold the pump flanges in place so that the mother does not have to hold them physically. This is a great recommendation to eliminate the static hand position. Manual pumps also involve highly repetitive movement for each pumping cycle, so an electric pump is preferable from an ergonomic standpoint if possible.

A referral to a lactation consultant may also be appropriate for mothers who need additional support in finding comfortable and ergonomically sound breastfeeding positions. A lactation consultant and a therapist can work well together in this context — the lactation consultant addressing feeding strategies, and the therapist addressing ergonomic and joint-protection components. The overall goal for nursing and bottle feeding is to decrease static load and repetitive strain during feeding tasks.

Lifting and Carrying Baby

Lifting and carrying the baby is one of the most commonly associated movements with De Quervain's and mommy's thumb. The problematic pattern comes from wrist deviation and flexion combined with thumb abduction. We can educate mothers on a scooping technique — keeping the thumb more adducted, closer to the other digits rather than out to the side in an abducted position — when lifting, carrying, or supporting the baby's head and neck. It could be lifting the baby from out of the crib, out of the car seat, out of the stroller, up from a play mat. Whatever the context, educating on that scooping pattern is key.

We also want to encourage using the forearms when possible. For example, when lifting from a stroller or car seat, if the mother can use at least one forearm to support the baby rather than relying on both distal hands and wrists, that significantly reduces the load on the first dorsal compartment. We want to avoid static posturing and encourage alternating sides. And we want to encourage the use of pillows for support during any activity that involves prolonged holding.

Baby wearing is a strategy I want to highlight specifically because we are seeing more of it now than in previous years. Baby wearing is almost like a backpack, with the baby strapped to the mother. These can be carriers with straps that go around the chest, sometimes slings. Baby wearing allows the trunk to take more of the weight. The proximal joint, the shoulder, bears the load, and the weight is dispersed over a larger area of the body rather than concentrated at the distal hand and wrist. Importantly, the hands are free. This is a really great suggestion for load distribution.

There are a variety of baby-wearing options. Carriers with chest straps, slings, and, as the baby develops head and neck control and gets older, hip carriers that function almost like a belt with an extender for the baby to sit on. All of these mechanisms help support the baby's weight so that the distal joints of the hand and wrist do not have to carry it and absorb that repetitive, low-grade stress. The overall goal for lifting and carrying is to decrease static load and repetitive strain, using adaptive equipment and supports whenever possible to assist with load distribution.

Bathing

Bathing is another area to examine from an ergonomic standpoint. If there are infant bath supports that can be placed in the tub to support the baby's head and neck, they may significantly reduce hand demands during the bath. The scooping technique and using the forearms when possible are good strategies for the transitions into and out of the bathing area, because the baby does need to be lifted and placed in. For smaller infants, there are usually more portable tubs or smaller basins that the baby can sit in, or possibly a sink setup if that works in the home.

If the hands are the only support for the baby during bathing, we want the mother to alternate right and left sides to avoid static posturing. We also want to prevent the forward-flexed posture that by nature places more stress on the distal joints. We must consider where in the home the mother can safely bathe the baby, and whether the tub or basin can be placed at counter height if possible. We want to avoid any wringing motion, which is also relevant for mothers using cloth diapers. The use of ergonomic strategies and joint protection principles is key to assisting with load distribution. The overall goal of bathing is to reduce static load and repetitive strain when supporting the baby's head, using ergonomic and joint-protection strategies throughout.

Diaper Changing

For diaper changes, alternating sides when wiping is an important habit to establish early. New mothers typically lean toward their dominant hand for wiping, but alternating wipes distribute the force between the right and left sides. We want to avoid extreme wrist positions during the wiping motion and encourage keeping supplies nearby so the mother does not have to reach or position awkwardly. From an ergonomic standpoint, a changing table at counter height is preferable. For mothers using cloth diapers, avoiding the wringing motion when washing or changing them is important. The goal for diaper changing is to reduce repetitive strain during the wiping motion and to use ergonomic and joint-protection strategies in the environmental setup.

Bottle Cleaning and Meal Preparation

In the infant stage, feeds are very frequent, like every couple of hours throughout the 24-hour period. With that frequency comes many bottle parts and pump parts that need to be washed and cleaned. When bottle cleaning, we want to avoid extreme wrist positions and avoid a static grasp on the bottles. Alternating right and left hands for opening and closing bottle parts is encouraged. New parents often tighten bottles very firmly to prevent leaks, which makes them very difficult to loosen. We can consider whether any assistive devices are available to help open bottles or provide friction to reduce torque at the joints of the hand and wrist.

Taking breaks when possible and avoiding highly repetitive movements are general principles here. The goal is to decrease static load and repetitive strain when opening, closing, and cleaning bottle parts. We would encourage the use of bottle brushes with larger handles and a basin at counter height if the mother is washing from a basin, to assist with load distribution and ergonomic setup.

General Ergonomic Principles for New Parents

Beyond the specific childcare tasks, there are general principles we want to convey to our new mothers during the prenatal stage so they are set up for success and can mitigate the risk of De Quervain's onset. We want them to avoid extreme wrist and thumb positions when possible and to develop that habit from day one as they are learning these childcare routines. Getting in the habit early matters because once patterns are established, they become automatic, and we want those automatic patterns to be protective ones.

We want to emphasize alternating sides between right and left across all activities. We want to emphasize proximal joints and the trunk for heavy loads and lifting, returning to the basics of body mechanics. We want to distribute the load by using two hands rather than one for heavy lifting and by favoring proximal joints over distal joints, especially in the postpartum period when the core is still recovering. Using breathwork and core activation to promote improved posture is also important. Posture plays a role in how we use our extremities, and with improved posture, the likelihood of placing stress on the distal joints decreases. Taking rest breaks when needed to avoid repetitive engagement in tasks is critical because De Quervain's typically develops from that low-grade repetitive stress. As a reminder, we know that De Quervain's typically results from repetitive, low-grade resistance applied to the area. Thus, anything we can do to interrupt the repetitive pattern, even briefly, is protective.

Mindfulness in Everyday Life

Our new mothers are not only engaging in childcare activities as a primary role throughout their day. They may be returning to work, returning to hobbies or exercise, and engaging in many alternative tasks. We want to analyze those appropriately and make suggestions and equipment recommendations when appropriate. We are providing a comprehensive, holistic analysis of our client by addressing all of these areas — not just the childcare component in isolation, but the full occupational picture.

General ergonomic recommendations outside of child-rearing tasks are key to this comprehensive approach. If the new mother is returning to work, does she have an ergonomic desk setup? If she is returning to a specific hobby or form of exercise, what does that look like from an ergonomic lens? Do those activities involve repetitive wrist and thumb loading that compounds what is already happening at home with the baby? General joint protection strategies outside of childcare tasks are equally important, especially if the new mother is returning to a job that involves significant hand and wrist use. Postural exercises are also a key component, particularly for managing repetitive strain and musculoskeletal injuries of this nature.

New mothers, especially in the early weeks, may have frequent wake windows and increased cell phone use, like more scrolling at odd hours of the evening. And while De Quervain's is known as mommy's thumb, it is also known as texting thumb for a reason. What cell phone recommendations can we make? Can we suggest a pop socket on the back of the phone or a case that supports the phone so the hand and thumb do not have to? Can we recommend using a stylus to text, as opposed to the thumb doing all the movement across the keyboard? The same considerations apply to computer use and ergonomic setup — especially for our breastfeeding mothers who may be managing work tasks or phone use during longer feeding sessions.

One particularly practical suggestion worth highlighting specifically for new mothers is related to water bottles. It is very common for new mothers to carry a large water bottle or canister, and some of those are very wide and have no handle. The new mother is then engaging in significant thumb abduction just to grasp the bottle, and if it is full, it is also heavy. We can instruct our clients to look for a water bottle with a handle so they can use a hook grasp rather than the wide abducted thumb position. It is a small change with a meaningful protective effect over the course of a day of repeated bottle-picking.

The overarching message in this section is that De Quervain's does not happen in a vacuum — it happens at the intersection of everything a new mother is doing across her day. Our role is to see the full picture of her daily life and to offer strategies across all of those areas, not only the ones that take place in the nursery.

Conclusion

Pregnant women often present with multiple risk factors for De Quervain's tenosynovitis, positioning rehabilitation clinicians to play a critical role in providing preventative education to mitigate symptom onset, preserve function, and promote maternal quality of life and participation.

Returning to our learning outcomes: we have described the anatomical considerations and risk factors specific to De Quervain's tenosynovitis during the prenatal and postpartum periods, including the anatomy of the first dorsal compartment, the roles of fluid retention and hormonal changes, the hormone relaxin, the impact of gestational diabetes, the biomechanical demands of infant caregiving, the influence of baby size and developmental stage, and the postural and biomechanical implications of pregnancy and the postpartum period. We have explained preventative strategies and ergonomic principles that therapy practitioners can apply to reduce strain and promote optimal hand function, including body mechanics training, equipment recommendations across feeding, carrying, bathing, and diapering, general joint protection principles, and comprehensive activity analysis across all of the new mother's roles. And we have identified key activity modifications across the six primary childcare task areas — nursing and bottle feeding, lifting and carrying, bathing, diaper changing, bottle cleaning and meal preparation, and general ergonomic mindfulness in everyday life — that support early intervention and prevention of De Quervain's Tenosynovitis.

I hope today's information has given you insight, and that when you treat clients with De Quervain's who are new mothers, you have more information to provide high-quality care and address all aspects of their maternal roles.

References

See the additional handout.