de Quervain’s Tenosynovitis

de Quervain's Tenosynovitis

Article by J.Miller, Z.Russell

What is de Quervain’s Tenosynovitis?

de Quervain’s tenosynovitis affects two thumb tendons called the abductor pollicis longus (APL) and the extensor pollicis brevis (EPB).

The APL and EPB tendons travel side by side through a tunnel near the end of the radius bone of the forearm. The tunnel helps hold the tendons in place, like the guide on a fishing pole.

de Quervain's Tenosynovitis

This tunnel lining is a slippery coating called tenosynovium. The tenosynovium allows the two tendons to glide smoothly back and forth as they move the thumb. Inflammation of the tenosynovium and tendon is called tenosynovitis.

In de Quervain’s tenosynovitis, non-inflammatory thickening of the tendons inflammation constricts the movement of the tendons within the tunnel irritating.

Causes of de Quervain’s Tenosynovitis

  • Repeated hand and thumb motions such as grasping, pinching, squeezing, or wringing may lead to the inflammation of tenosynovitis. This inflammation can lead to swelling, which restricts the smooth gliding action of the tendons within the tunnel.
  • Arthritic diseases that affect the whole body, such as rheumatoid arthritis, can also cause tenosynovitis in the thumb.
  • Scar tissue from an injury can make it difficult for the tendons to slide easily through the tunnel.
  • In many cases, the pain presents after no direct mechanism or unusual activity.

Symptoms of de Quervain’s Tenosynovitis

At first, the only sign of trouble may be soreness on the thumb side of the forearm, near the wrist. Untreated, the pain may spread up the forearm or further down into the wrist and thumb.

As the friction increases, the two tendons may begin to creak as they move through the constricted tunnel. This noise is called crepitus. If the condition is severe, there may be swelling along the tunnel near the edge of the wrist. Grasping objects with the thumb and hand may become increasingly painful.

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 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 relatively easy. Most of the time, no fancy tests are required.

Finklestein test

The Finklestein test is one of the best ways to make a diagnosis. You can do this test yourself. Bend your thumb into the palm. Grasp the thumb with your fingers making a fist with the thumb inside. Now bend your wrist away from your thumb in a side to side motion. If you feel pain over the thumb tendons, your problem is probably de Quervain’s tenosynovitis.

For specific advice regarding your wrist pain, please consult your physiotherapist or doctor.

Treatment of de Quervain’s Tenosynovitis

Your healthcare practitioner is the best person to advise you on treating your de Quervain’s tenosynovitis individually. They can utilise various local modality and soft tissue treatment options to assist your recovery. Until your assessment, 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 wrist movements.
  • Keep the wrist in a neutral alignment. In other words, please keep it in a straight line with your arm, without bending it forward or backward.

Thumb-Spica Splint

Your physiotherapist or doctor may suggest that you wear a unique forearm and thumb splint called a thumb spica splint. This splint keeps the wrist and lower joints of the thumb from moving. The brace allows the APL and EPB tendons to rest, giving them a chance to begin to heal.

Glucocorticoid Injections

A glucocorticoid injection administered between the two painful APL and EPB tendons may provide symptomatic relief of de Quervain’s tenosynovitis. The combined use of splints and glucocorticoid injections is more beneficial than just splinting alone. But, de Quervain’s tenosynovitis is rarely a longstanding injury.

Physiotherapy

The main focus of physiotherapy is to reduce or eliminate the cause of irritation of the thumb tendons. Your physiotherapist may check the way you do your work tasks. Suggestions regarding the use of healthy body alignment and wrist positions, de Quervain’s tenosynovitis supports helpful exercises and tips on preventing future problems.

You’ll begin doing active hand movements and range-of-motion exercises. Your physiotherapists may use ice packs, soft-tissue massage, and hands-on stretching to settle the condition and restore any lost range of motion.

Strengthening your hand and thumb may use handy products such as hand eggs or exercise putty. Therapists also use a series of gentle stretches to encourage the thumb tendons to glide smoothly within the tunnel.

As you progress, your therapist will give you exercises to help strengthen and stabilise the muscles and joints in the hand and thumb. Some of the exercises you’ll do get your hand working similarly to your work tasks and sports activities.

Your therapist will help you find ways to do your tasks that don’t put too much stress on your thumb and wrist. Before your therapy sessions end, your therapist will teach you several ways to avoid future problems.

For specific advice regarding your de Quervain’s tenosynovitis, please consult your hand and wrist physiotherapist.

Acute Injury Signs

Acute Injury Management.

Here are some warning signs that you have an injury. While some injuries are immediately evident, others can creep up slowly and progressively get worse. If you don't pay attention to both types of injuries, chronic problems can develop.

For detailed information on specific injuries, check out the injury by body part section.

Don't Ignore these Injury Warning Signs

Joint Pain

Joint pain, particularly in the knee, ankle, elbow, and wrist joints, should never be ignored. Because these joints are not covered by muscle, pain here is rarely of muscular origin. Joint pain that lasts more than 48 hours requires a professional diagnosis.

Tenderness

If you can elicit pain at a specific point in a bone, muscle, or joint, you may have a significant injury by pressing your finger into it. If the same spot on the other side of the body does not produce the same pain, you should probably see your health professional.  

Swelling

Nearly all sports or musculoskeletal injuries cause swelling. Swelling is usually quite obvious and can be seen, but occasionally you may feel as though something is swollen or "full" even though it looks normal. Swelling usually goes along with pain, redness and heat.

Reduced Range of Motion

If the swelling isn't obvious, you can usually find it by checking for a reduced range of motion in a joint. If there is significant swelling within a joint, you will lose range of motion. Compare one side of the body with the other to identify major differences. If there are any, you probably have an injury that needs attention.

Weakness

Compare sides for weakness by performing the same task. One way to tell is to lift the same weight with the right and left sides and look at the result. Or try to place body weight on one leg and then the other. A difference in your ability to support your weight is another suggestion of an injury that requires attention.

Immediate Injury Treatment: Step-by-Step Guidelines

  • Stop the activity immediately.
  • Wrap the injured part in a compression bandage.
  • Apply ice to the injured part (use a bag of crushed ice or a bag of frozen vegetables).
  • Elevate the injured part to reduce swelling.
  • Consult your health practitioner for a proper diagnosis of any serious injury.
  • Rehabilitate your injury under professional guidance.
  • Seek a second opinion if you are not improving.

Arm Pain Causes

Arm pain and injuries are widespread. Arm pain can occur as a result of either sudden, traumatic or repetitive overuse. The causes can be related to sports injuries, work injuries or simply everyday arm use.

Arm pain can be a local injury, musculoskeletal injury or could even be referred from nerves in your neck (cervical radiculopathy). This can result in neck-arm pain.

Causes of Arm Pain by Region

Causes of Arm Pain by Structure

Neck-Related Arm Pain

Shoulder-Related Arm Pain

Elbow-Related Arm Pain

Wrist-Related Arm Pain

Hand-Related Arm Pain

Muscle-Related Arm Pain

Other Sources of Arm Pain

Common Causes of Arm Pain

The most common sources of arm pain include shoulder painwrist pain and elbow pain.

Referred Arm Pain

As mentioned earlier, arm pain can be referred to from another source. Cervical radiculopathy is a common source of referred arm pain. Cervical radiculopathy will not respond to treatment where you feel the arm pain. However, it will respond positively to treatment at the source of the injury (e.g. your neck joints).

Professional assessment from a health practitioner skilled in diagnosing both spinal-origin and local-origin (muscle and joint) injuries (e.g. your physiotherapist) is recommended to ensure an accurate diagnosis and prompt treatment directed at the arm pain source.

Arm Pain has Diverse Causes.

The causes of your arm pain can be extensive and varied. Due to this diversity, your arm pain should be assessed by a suitably qualified health practitioner to attain an accurate diagnosis, treatment plan and implementation specific to your arm pain.

What Arm Pain is Associated with a Heart Attack?

Left-arm pain can be an early sign of a life-threatening cardiac issue. Based on this, a professional medical assessment that involves an accurate history, symptom analysis, physical examination and diagnostic tests to exclude a potential heart attack is important to exclude this potentially life-threatening source of arm pain.

For more information, please consult with your health practitioner, call an ambulance on 000, or visit a hospital emergency department to put your mind at ease.

Good News. Most Arm Pain is NOT Life-Threatening.

Luckily, life-threatening arm pain is far less likely than a local musculoskeletal injury. Arm pain caused by a localised arm muscle, tendon or joint injury should be assessed and confirmed by your health practitioner before commencing treatment.

Arm Pain Prognosis

The good news is that arm pain, and injury will normally respond very favourably to medical or physiotherapy intervention when early professional assessment and treatment is sought. Please do not delay in consulting your healthcare practitioner if you experience arm pain.

Common Arm Pain Treatments

With accurate assessment and early treatment, most arm injuries respond extremely quickly to physiotherapy or medical care, allowing you to resume pain-free and normal activities of daily living quickly.

Please ask your physiotherapist for their professional treatment advice.