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Pregnancy-related carpal tunnel syndrome and De Quervain’s
8 Plays11 minutes ago
In this episode, Miranda and Josh compare pregnancy-related carpal tunnel syndrome and De Quervain’s from a treatment perspective, highlighting differences in intervention strategies and progression.
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Transcript
Introduction to the Hand Therapy Academy
00:00:00
josh MacDonald
It's so active.
00:00:06
josh MacDonald
Hi, I'm Josh McDonald.
00:00:08
Miranda Materi
And I'm Randa Matieri and we are Ham Therapy Academy.
Pregnancy-Related Conditions: Dequeur Veins & Carpal Tunnel
00:00:11
josh MacDonald
Let's talk a little bit about treating pregnancy-related dequeur veins, carpal tunnel syndrome, maybe cubital tunnel, all of these kind of soft tissue-related things that happen when someone's pregnant.
00:00:23
Miranda Materi
Yeah, and even post pregnancy, right?
00:00:25
josh MacDonald
Yeah.
00:00:26
Miranda Materi
So these conditions can continue on. They may have had some mild symptoms first and then it slowly went away or or maybe then the pregnancy made it worse. So I feel like we get a fair amount of these. I'm not sure why, but in our claim, do you see a fair amount of them?
00:00:45
josh MacDonald
um It comes in spurts. Like a lot of our diagnoses, it's like we'll see some for see a bunch for a while and then none for a while. And then we'll have two or three at the same time. So it kind of
Marketing & Patient Inflow from OBGYNs
00:00:54
josh MacDonald
comes and goes. Yeah.
00:00:55
Miranda Materi
Yeah, I think i was taking care of an OB b doctor and he was like, this is fantastic.
00:00:55
josh MacDonald
Yeah.
00:01:00
Miranda Materi
So then he's like thinking now he needs to send.
00:01:01
josh MacDonald
Yeah.
00:01:03
josh MacDonald
Yeah. And I think it usually ties to when we market to the OBGYN that's across the street from us and we'll get two or three right away. And then she kind of forgets and then we go market again. Yeah.
00:01:13
Miranda Materi
there you go.
00:01:13
josh MacDonald
Yeah.
Treatment Modifications & Patient Education for Pregnant Patients
00:01:14
Miranda Materi
Okay, so what are you doing for these patients?
00:01:14
josh MacDonald
Yeah.
00:01:16
Miranda Materi
Do you treat them any differently? You know, all of those things.
00:01:21
josh MacDonald
Yeah, yeah. So let's work first under the assumption that they are, they don't have the kid yet. They're still pregnant. um I usually, like I'm, there's some contraindications about some of the modalities. I'm not using laser. um I'm not using, and I don't usually, but I wouldn't use iontrophoresis on some of these patients. I wouldn't use any electrical Easton based stuff.
00:01:40
josh MacDonald
um I know that their system, um, their whole global system, hormones, ah everything, soft tissue responses is going to be kind of amplified. So I'm treating them a lot more like, uh, I'll say cautiously, if I'm going to do I stim, I'm going like 20% lighter on things. Cause they can be really sensitive to some of that input.
Post-Delivery Challenges & Therapist Support
00:02:02
josh MacDonald
Nerves are kind of turned on high alert.
00:02:04
josh MacDonald
Um, so I'm still doing the same kind of, we start with quit poking the bear and, try to immobilize like if it's a dequerive veins i'm doing a form base them spica say let's calm the area down first then let's get some pain-free active range of motion and then maybe some light dynamic loading i'm still working through that general progression i'm just kind of turning the dial down because we have kind of this pending deadline of whenever that kid comes and life gets uber chaotic and it's super hard for them to come back so we need to make as much progress as possible before that that delivery
00:02:39
Miranda Materi
Right. And then the education behind it, right? Like once they have this, the baby is, it's their first baby. How do you hold the baby? Right. Cause a lot of times new moms will get D queer veins or new dads can get D queer veins.
00:02:50
Miranda Materi
So it's a lot of positioning stuff that, um, they'll need to learn. And then also there's a lot of sleep deprivation goes with this. So then it's like, you know, educating about sleep, you know, like there's, I feel like there's a lot we can do is as therapists, especially, you know, as OTs and kind of taking this holistic approach.
00:02:58
josh MacDonald
Yeah.
Chronic Stage Treatments for New Parents
00:03:08
Miranda Materi
of what what that's going to look like.
00:03:10
josh MacDonald
Yeah, yeah. And i I unfortunately don't feel like we have these amazing, fantastic outcomes with this population. It can be a little bit of a stubborn thing because as they're progressing on, they usually don't get to us until things are pretty involved because they're dealing with it, they're working through it, it's not that big a deal. And then by the time they mention it to their OBGYN or family practitioner, whoever,
00:03:34
josh MacDonald
It's like, this is really a problem. And then they end up on our doorstep and it's pretty, we're we're past that acute phase. And now we're in more of the chronic stage of it where it's much harder. It's a long road for anybody. Nevermind someone whose body is still kind of going through this chaos.
00:03:49
Miranda Materi
Right. um One thing I think that's been helpful for a couple of my patients was doing a TENS unit.
00:03:55
josh MacDonald
Okay.
00:03:56
Miranda Materi
you know And especially when they can't sleep or it's a constant pain, i' just that's an easy one where they can just you know put the little pack on their belt and wear it around.
00:04:07
Miranda Materi
you know They either and do it on burst mode, which hopefully you have a little more carryover, or um just keep it running continuously. Yeah.
00:04:14
josh MacDonald
Yeah. Yeah. That's a great idea. Yeah. Would you have them wear that at the same time as a Thumb Spica, like underneath the Thumb Spica?
00:04:21
Miranda Materi
Oh, sure.
00:04:22
josh MacDonald
Okay. Yeah. Cool.
00:04:24
Miranda Materi
Why not?
00:04:25
josh MacDonald
Yeah. And those have become so easy to get now. Like it's like 15 bucks on Amazon and you can get a attends unit. Yeah. Yeah.
00:04:34
Miranda Materi
And I don't think it's like, wow, that's like significant. You know, like, it's not like you're getting like 100% relief, but it's something, especially when you already have so
Complexities of Post-Birth Physical Challenges
00:04:43
Miranda Materi
much discomfort. Sometimes a little bit can be a lot.
00:04:46
josh MacDonald
Yeah, yeah. And it's like, which I mentioned earlier, you have this kind of like, impending deadline of, you know, when that baby comes, they're not going to be able to come for a while, maybe again. And so you're trying this progress, but sometimes you get them after they've had the baby.
00:05:03
josh MacDonald
And now you're trying to deal with the patient. Who's got a little one next to them in the clinic. And they're like, here's, you know, this, this is the the kid, but I've also got this thing. And so it's real tough to do like activity modification and all that education when they're like, I can't change a diaper with this thing on, or gets gross. And I can't lift them with it on. so it's like trying to find them problem solve with those patients is is a challenge too.
00:05:27
Miranda Materi
Right, yeah, definitely. And then they're sleep deprived. I think too, sometimes it's just acknowledging like, yeah, this is really hard on your body. you know it's It's really hard on your body and it's gonna take you know maybe sometimes six to month to a year before you really feel like better
00:05:35
josh MacDonald
Yeah.
00:05:41
josh MacDonald
Yeah. Yeah. And a lot of times for these patients, their hand, thumb or carpal tunnel symptoms are not the only physical challenge they're dealing with. And so we have to be sensitive to like, OK, what how big is the problem in is this compared to some of the other stuff they may be going through of, you know, post delivery issues or ah like, oh, my hips are bugging me or, you know, those kinds of things.
Hormone Fluctuations & Joint Mobility
00:06:05
josh MacDonald
This may not be the only thing they're dealing with.
00:06:07
Miranda Materi
Yeah, definitely. And then that's another thing, you know, when you you have someone that has all those hormone fluctuations is that their joints are more mobile as well, right? So if you're going to be doing any joint glides or, you know, you want to be careful with that anyways, but just realize that they have more elasticity too. So how they would respond without those increased hormones will be different than how they would respond normally.
00:06:31
josh MacDonald
Yeah, yeah. I will sometimes give patients options as far as other, like if they're in a stage where they need splinting, we'll maybe talk about soft splinting, neoprene options, something that will give them some measure of support, but still give them the mobility they need to do to take care of the baby, do, you know, if if they're working at the same time and trying to manage life, but taking some measure of load off of whatever structures are involved.
Injections: A Common, Imperfect Solution
00:06:54
Miranda Materi
Yeah, do you feel like um the patients you have when they're postpartum, do a lot of them get injections?
00:07:02
josh MacDonald
Um, yes, I would say probably 50% get injections and of those that do, I would say probably 50% of those ended up glad they did it or, or it worked for them.
00:07:14
josh MacDonald
I should say like, yeah.
00:07:15
Miranda Materi
Yeah. I feel like with the D-queer veins, we get a lot of them that end up going on to get injections and then they feel better, you know, they usually, but they still don't, it's not perfect, but they're like, oh, it's much better than what it was.
00:07:26
josh MacDonald
Yeah.
00:07:28
Miranda Materi
It takes the edge off of it.
00:07:29
josh MacDonald
Yeah, yeah. And if that's what it takes to take the edge off so they can function, that's fine. And we had a patient who showed up on our doorstep from ah an OBGYN. She's actually like a nurse midwife. She referred to us for conservatives. She came in and said, no, no, no I want injections.
00:07:45
josh MacDonald
Like all my friends had this when they had babies. I just want the same injection they got. And so we sent her across the street to a hand surgeon's PA and said, if that's what you're looking for, fantastic. Here's a resource for it. They got her and they did the injection same day. And that's a perfectly fine answer. There's nothing wrong with
Listener Engagement & Questions
00:08:01
josh MacDonald
that.
00:08:01
Miranda Materi
Yeah, that's certainly an answer for sure.
00:08:03
josh MacDonald
Yeah. Yeah. All right. So it's not necessarily one of our more common diagnoses, but it does come up a little bit. So if you have any questions about it, shoot us a message or you can reach out to us on our email at info at hand therapy academy.com.