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).
On their way to the thumb, the APL and EPB tendons travel side by side along the inside edge of the wrist. They pass 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.
This tunnel is lined with a slippery coating called tenosynovium. The tenosynovium 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
- 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.
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. If the problem isn't treated, pain may spread up the forearm or further down into the wrist and thumb.
As the friction increases, the two tendons may actually 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.
How Does Your Physiotherapist Confirm the Diagnosis?
The diagnosis of de Quervain's tenosynovitis is quite easy. Most of the time no fancy tests are required.
The Finklestein test is one of the best ways to make the diagnosis. You can do this test yourself. Bend your thumb into the palm and 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 tendons to the thumb, your problem is probably de Quervain's tenosynovitis.
Treatment of de Quervain's Tenosynovitis
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 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.
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 may be given about 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 easily within tunnel.
As you progress, your therapist will give you exercises to help strengthen and stabilize the muscles and joints in the hand and thumb. Other exercises are used to improve fine motor control and dexterity. Some of the exercises you'll do are designed get your hand working in ways that are similar to your work tasks and sport 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 a number of ways to avoid future problems.
Common Treatments for de Quervain's Tenosynovitis
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Related Injuries
Carpal Tunnel Syndrome
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