| Age / Sex | 42-year-old female |
| Occupation | Freelance graphic designer and new mother (8-month-old) |
| Primary Complaint | Sharp pain at the base of the thumb and radial wrist, worse with gripping, lifting her baby, and using a mouse |
| Duration of Symptoms | 8 months (onset shortly after childbirth) |
| Previous Treatments | Thumb spica splint, cortisone injection (1x), rest from design work, NSAIDs |
| Diagnosis | De Quervain’s tenosynovitis with contributing postural dysfunction from nursing posture and workstation ergonomics |
Background
This 42-year-old graphic designer had been managing her freelance career and a newborn when the thumb pain started. At first she blamed it on the repetitive clicking and scrolling of her design work. But as it worsened, she realized the pain was worst when lifting her baby, fastening car seat buckles, and wringing out washcloths. Simple tasks she had done her entire life were suddenly excruciating.
Her doctor diagnosed De Quervain’s tenosynovitis, common in new mothers from the repetitive lifting and wrist positions involved in infant care. A cortisone injection provided three weeks of near-complete relief, then the pain returned. The thumb spica splint was impractical with a baby to hold. She could not take extended time off from her freelance work without losing clients. She came to us frustrated and anxious that she might need surgery.
Assessment Findings
The first dorsal compartment tendons were inflamed and Finkelstein’s test was strongly positive, confirming the De Quervain’s diagnosis. But the assessment revealed additional contributing factors that explained why treatments focused on the wrist alone had not held. Her thoracic spine was rounded forward from months of nursing in a flexed posture. Her shoulders were protracted and internally rotated. This altered the entire upper extremity chain, placing excess load on the wrist extensors and thumb tendons with every gripping task.
Her workstation setup was also problematic. She was working on a laptop at the kitchen table, with her wrists in sustained extension and ulnar deviation, the exact positions that aggravate De Quervain’s. The combination of postural dysfunction from nursing and ergonomic stress from her work setup created a perfect storm for the tendon sheath.
Treatment Protocol
Phase 1 Weeks 1-2 | Focused shockwave therapy (F-ESWT) to the first dorsal compartment to promote tendon healing and reduce inflammation. Education on infant lifting mechanics to reduce wrist strain: scooping with forearms, avoiding the L-shaped thumb grip. Thoracic spine mobilization to begin addressing the nursing posture. |
Phase 2 Weeks 2-4 | Continued F-ESWT. Complete workstation ergonomic redesign: external monitor at eye height, separate keyboard with wrist-neutral positioning, vertical mouse. DNS-based postural retraining focused on restoring thoracic extension and scapular positioning. Gentle grip strengthening as tolerated. |
Phase 3 Weeks 4-5 | Progressive loading of thumb and wrist. Full return to design work with new ergonomic setup. Home exercise program for postural maintenance. Nursing posture optimization with pillow support strategies. |
Progress Timeline
| Months 1–3 (Pre-Treatment) | Wore thumb spica splint and took NSAIDs for wrist pain. Received one cortisone injection — temporary improvement. Attempted rest from design work, but symptoms flared upon return to the keyboard and mouse. |
| ▸ Treatment at City Integrative Rehabilitation | |
| Week 1 | First F-ESWT session. Lifting technique modifications provided immediate reduction in flare-ups. Pain reduced approximately 30% within days. |
| Week 2 | Second F-ESWT session. Finkelstein’s test notably less provocative. Could open jars without the sharp catching pain. |
| Week 3 | New workstation installed. Wrist pain during design work reduced dramatically. Could work 3-hour sessions without stopping. |
| Week 4 | Lifting baby without pain. Car seat buckles no longer a problem. Resumed full freelance workload. |
| Week 5 | Pain fully resolved. Finkelstein’s test negative. Full grip strength restored. Discharged with home maintenance program. |
Outcome
In five weeks, this new mother went from being unable to lift her baby without pain to full resolution of her De Quervain’s symptoms. Focused shockwave therapy addressed the tendon pathology directly, while ergonomic redesign of her workspace and education on infant handling mechanics eliminated the repetitive stresses perpetuating the condition. Correcting her nursing posture and restoring thoracic mobility ensured the entire upper extremity chain was functioning properly, not just the wrist.
This case study represents a real patient treated at City Integrative Rehabilitation. Details have been modified to protect patient privacy. Individual results may vary.