What is the cause and cure for acute pain in the wrist?

Q: I woke up about 4 months ago with a terrible pain in my right wrist (thumb side). I was, then, in my 34th week of pregnancy (second pregnancy). Doctor said that the pain would go away with delivery. It didn't. Today the pain is still there and is worse than ever before. I consulted an orthopaedician, who diagnosed it as deQuervains Tenosynovitis and advised physiotherapy for 10 days and elasto-wrist band. I underwent the therapy with no appreciable benefit. At times the pain radiates up the forearm. What should I do? I have heard of cortisone injections and I believe that they are very painful. I am still breast feeding my 3 month old son and I intend to continue breast feeding him for another 3 months. I am a 35 years old housewife and have to carry out the usual household chores. I shall be grateful for any advice.

A:I assume that your diagnosis is correct. deQuervains disease is commonly seen to be aggravated by over use of the hand and soon after pregnancy. One way of confirming diagnosis is by clutching the thumb in the palm and trying deviate the wrist away from the thumb side. This will cause aggravation of your symptoms. If you have tried Elasto wrist band you could try a wrist splint that restricts movements of the wrist but permits wrist to the joint to allow relief. As you are breast feeding it will be safer to avoid anti-inflammatory drugs unless pain is very severe. I do not like to give steroids as there is always a risk of tendon rupture. It will be safer to splint and avoid activities that over use the thumb side movement of the wrist and palm. Anyway, steroids are not recommended in chronic cases like yours. In chronic cases the tendon sheath gets so swollen that nothing works. in such cases a small surgical release helps relieve symptoms and improve movements.