de Quervain's Tenosynovitis
Article by John Miller
What is de Quervain's Tenosynovitis?
de Quervain's tenosynovitis affects two thumb tendons: the abductor pollicis longus (APL) and the extensor pollicis brevis (EPB).
The APL and EPB tendons travel side by side along the inside edge of the wrist. They pass through a synovial tunnel near the thumb side of your wrist. The tunnel helps hold the tendons in place.
This tunnel is lined with a slippery coating called tenosynovium, which allows the two tendons to glide easily back and forth as they move the thumb. Inflammation of the tenosynovium and tendon is called tenosynovitis. In de Quervain's tenosynovitis, the inflammation constricts the movement of the tendons within the tunnel.
Causes of de Quervain's Tenosynovitis
de Quervain's tenosynovitis is basically a combination of overuse and poor hand on wrist posture.
Symptoms of de Quervain's Tenosynovitis
de Quervain's usually starts as soreness on the thumb side of the forearm, near the wrist. When left untreated, pain may spread up the forearm or further down into the wrist and thumb.
The two tendons may actually begin to creak as they move through the constricted tunnel. This noise is called crepitus. You may notice swelling along the tunnel near the edge of the wrist. Grasping objects with the thumb and hand may become increasingly painful.
de Quervain's Tenosynovitis Diagnosis?
The diagnosis of de Quervain's tenosynovitis is normally confirmed by your physiotherapist on clinical examination. No fancy tests are required. The Finklestein test is one of the best ways to make the diagnosis.
Treatment of de Quervain's Tenosynovitis
Your physiotherapist is the best person to individually advise you how to treat your de Quervain's tenosynovitis. They can utilise various local modality and soft tissue treatment options to assist your recovery. Until you are assessed, please try the following.
Rest or Reduce Hand Movements
If at all possible, you must change or stop all activities that cause your symptoms. Take frequent breaks when doing repeated hand and thumb actions. Avoid repetitive hand motions, such as heavy grasping, wringing, or turning and twisting movements of the wrist. Keep the wrist in a neutral alignment. In other words, keep it in a straight line with your arm, without bending it forward or backward.
Your physiotherapist or doctor may want you to wear a special forearm and thumb splint called a thumb-spica splint. This splint keeps the wrist and lower joints of the thumb from moving. The splint allows the APL and EPB tendons to rest, giving them a chance to begin to heal.
Common Treatments for de Quervain's Tenosynovitis
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