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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 HSS | Hospital for Special Surgery
HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the eighth consecutive year) and No. 3 in rheumatology by U.S. News & World Report (2017-2018). Founded in 1863, the Hospital has one of the lowest infection rates in the country and was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center four consecutive times. The global standard total knee replacement was developed at HSS in 1969. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State. In 2017 HSS provided care to 135,000 patients and performed more than 32,000 surgical procedures. People from all 50 U.S. states and 80 countries travelled to receive care at HSS. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Global Innovation Institute was formed in 2016 to realize the potential of new drugs, therapeutics and devices. The culture of innovation is accelerating at HSS as 130 new idea submissions were made to the Global Innovation Institute in 2017 (almost 3x the submissions in 2015). The HSS Education Institute is the world’s leading provider of education on the topic on musculoskeletal health, with its online learning platform offering more than 600 courses to more than 21,000 medical professional members worldwide. Through HSS Global Ventures, the institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally.

Kate Larkin


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