De Quervain's Tenosynovitis is a painful, inflammatory condition caused by tendons on the side of the wrist at the base of the thumb. Pain, which is the main complaint, gets worse with when you turn your wrist, grasp anything or make a fist.
Commonly seen in those between 40-50 years and more commonly seen in women, new mothers, pregnant women, in those with history of lateral and medial epicondylitis and in those with jobs or hobbies involving repetitive hand and wrist movements.
Cause
The abductor pollicis longus (ABL) and the extensor pollicis brevis (EPB), that are the two muscles that are affected in De Quervain’s tenosynovitis. The tendons of the APL and EPB bound the triangular anatomical snuff box laterally. The snuff box is visible as a hollow on the lateral aspect of the wrist when the thumb is extended or abducted completely.
Tendons are rope like structures that attach muscle to bone. This helps in moving our fingers. Tendons are covered by a sheath that allows their smooth gliding.
The fluid within this sheath help in a friction free gliding.
Chronic overuse, such as repeating a particular hand motion day after day, causes irritation of the the covering around the tendons. As a result, the tendons thicken and swell. This thickening and swelling increase the friction and thus restrict the movement of the tendons through the small tunnel that connects them to the base of the thumb.
These changes happen in the 1st extensor compartment out of total 6 compartments in our wrist.
Symptoms
Symptoms of De Quervain's tenosynovitis include:
Pain near the base of the thumb
Swelling near the base of the thumb
Difficulty moving the thumb and wrist when doing something that involves grasping or pinching
A "sticking" or "stop-and-go" sensation in the thumb when moving it.
When De Quervain's tenosynovitis goes untreated, it can become difficult to use the hand and wrist properly. The wrist may lose some range of motion.
Treatment includes
Rest, splinting, and NSAIDs.
Failure of these may require surgery.
Physical therapy plays a major role in identifying the problem and in addressing it, thereby reducing the symptoms and helping the patient get back to regular routine at the earliest.
Physical therapy treatment aims at reducing pain, reducing swelling of the inflamed sheath, loosen the tight musculature, activity modification and strengthening the weak muscles.
Heat/ cold, Ultrasound and have been proven in reducing pain and swelling and in healing.
Graded strengthening program help in improving strength and function.
Deep tissue massage at the thenar eminence can help relax tight musculature that causes pain.
Taping can also be used to decrease pain and improve function
Literature on joint mobilizations in tendinopathies such as De Quervain's remains limited since the effect of these techniques have been sparsely reported in a few retrospective case-series and case studies.
Our physical therapists will be happy to identify the cause for your thumb and wrist pain and help you get back to your pain free routine; as we at Valley Healing Hands provide the best Physical Therapy and Occupational Therapy in Brownsville, Texas for thumb pain (De Quervain's tenosynovitis)
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