De Quervain’s Tenosynovitis

De Quervain’s Tenosynovitis is inflammation of two tendons on the side of the wrist at the base of the thumb results pain at the outside of the wrist. Pain is typically increased with gripping or rotating the wrist.

Figure: De Quervain’s Tenosynovitis

Causes

  1. Chronic overuse of the wrist
  2. Repetitive movements day after day cause irritation and pain
  3. One common movement that causes it is lifting a child into a car seat.
  4. Lifting heavy grocery bags by the handles.
  5. A direct injury to the wrist or inflammatory arthritis
  6. Hobbies like gardening or racket sports

Risk Factors:

Risk factors for de Quervain’s tenosynovitis include:

Age. If you’re between the ages of 30 and 50, you have a higher risk of developing de Quervain’s tenosynovitis than do other age groups, including children.

Sex. The condition is more common in women.

Being pregnant. The condition may be associated with pregnancy.

Baby care. Lifting your child repeatedly involves using your thumbs as leverage and may also be associated with the condition.

Jobs or hobbies that involve repetitive hand and wrist motions. These may contribute to de Quervain’s tenosynovitis.

Symptoms

  • Pain & swelling near the base of your thumb
  • Difficulty moving your thumb and wrist when you’re doing something that involves grasping or pinching
  • spasms, tenderness, occasional burning sensation in the hand
  • The onset is often gradual
  • A “sticking” or “stop-and-go” sensation in your thumb when moving it
  • radial sided wrist pain that radiates up the forearm with grasping or extension of the thumb

Diagnosis

  • Physical Examination: your doctor will examine your hand to see if you feel pain when pressure is applied on the thumb side of the wrist.
  • Special Test (Finkelstein test) ; The doctor will ask you to bend your thumb across your palm. Then you’ll bend your fingers down over your thumb to make a fist. This movement stretches your tendons. If it hurts on the thumb side of your wrist, you probably have de Quervain’s tenosynovitis.
  • Imaging: Imaging tests, such as X-rays, generally aren’t needed to diagnose de Quervain’s tenosynovitis.

Treatment

Initial treatment of de Quervain’s tenosynovitis may include:

  • Applying heat or ice to the affected area.
  • Avoiding activities that cause pain and swelling. Especially avoid those that involve repetitive hand and wrist motions.
  • Wearing a splint 24 hours a day for 4 to 6 weeks to rest your thumb and wrist.

Figure: wrist splint

  • Avoiding pinching with your thumb when moving your wrist from side to side.

Physiotherapy:

  1. Equipment:
  2. Electrical stimulation:
  3. Ultrasound Therapy: Ultrasound is thought to improve the treatment outcome and can be used as a diagnostic tool in the management of de Quervain’s disease.
  4. High Intensive Laser
  5. Infra Red Ray
  6. Manual:
  7. MFR (Myofascial Release)
  8. Stretching and Strengthening Exercise

Exercises include:

  • Thumb lifts

                                                Figure: Thumb lifting

  • Opposition stretch
  • Finkelstein stretch

Figure: Finkelstein stretch

  • Wrist flexion
  • Wrist extension

Figure: Wrist flexion & Extension

  • Wrist radial deviation strengthening
  • Eccentric radial deviation strengthening
  • Grip strengthening
  • Finger spring

It’s important for you to perform these exercises consistently to reduce your symptoms and prevent flare-ups. You can also use hot and cold therapy on your wrist.

Recovery

If you didn’t need surgery, you’ll probably get better in 4-6 weeks if you wear your splint, do your exercises and avoid movements that irritate your tendon.

Prevention:

The best way to prevent de Quervain’s tenosynovitis is by avoiding repetitive movements. Change your actions to reduce the stress on your wrists. Take frequent breaks to rest if you are using your wrists. Wear a brace or splint on your thumb and wrist, if necessary.

Follow the exercise routine suggested by your doctor or physical therapist. Be sure to tell him or her about any activities that cause pain, numbness, or swelling.

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