Just one additional comment:  I have had, and have seen in others,
significant tenosynovitis at the base of the thumbs from the repetitive
activity of hand expression of breast milk.  This responded to rest and
to a change in technique.  (Of course the best treatment for me was to
rearrange my schedule so that I could nurse instead of express....:-) )

--
Anne Montgomery, M.D.
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St.Peter Hospital Family Practice Residency
Olympia, WA