de Quervain’s Tenosynovitis

de Quervain's Tenosynovitis

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 especially bad, 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 quite 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 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 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 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.

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 how to prevent future problems.

You’ll begin doing active hand movements and range-of-motion exercises. Therapists also use ice packs, soft-tissue massage, and hands-on stretching to help with the range of motion. You may start carefully strengthening your hand and thumb by squeezing and stretching 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 in ways that are similar 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 advice specific to managing your de Quervain’s tenosynovitis, please consult your physiotherapist.

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