“Since the baby came my thumb-side wrist is agony when I lift her — it catches and it’s swollen”

DE QUERVAIN’S TENOSYNOVITIS is mainly thickening and narrowing of the sheath around the first dorsal extensor compartment tendons (abductor pollicis longus and extensor pollicis brevis) at the RADIAL wrist, so the tendons catch, presenting with pain and swelling over the radial styloid that is worse with thumb/wrist movement and gripping/lifting — classically in NEW MOTHERS (repeated lifting of the baby) and with repetitive thumb use. Confirm it clinically — a guided self-test on video, or FINKELSTEIN’S test face to face if unclear (the examiner holds the thumb and gently deviates the wrist towards the little finger, reproducing the radial-styloid pain — the thumb-in-fist version is Eichhoff’s test, more often positive in normal wrists) and first-compartment tenderness/swelling; imaging is not routinely needed. Distinguish it from thumb-base (first CMC joint) osteoarthritis (older patients, base-of-thumb pain), scaphoid pathology (trauma, snuffbox tenderness), intersection syndrome (more proximal) and inflammatory arthritis (other joints/systemic features). Manage conservatively first: activity modification and baby-handling/ergonomic advice (lift with the forearm rather than thumb-abducted scooping), a THUMB SPICA splint to rest the thumb/wrist, analgesia/NSAIDs (topical or oral, after asking whether she is breastfeeding — BNF), and relative rest — most settle with these. If not settling, a local corticosteroid injection into the tendon sheath relieves symptoms for many (BSSH; counsel skin thinning or lightening, infection, temporary flare), and refractory cases are referred to hand/orthopaedics for surgical decompression. Reassure it is treatable and usually self-limiting with the right measures, give practical ergonomic advice tailored to childcare, ask about her emotional wellbeing (NICE NG194), and safety-net.