De Quervain’s Tenosynovitis

WHAT IS DE QUERVAIN’S TENOSYNOVITIS?

De Quervain’s tenosynovitis occurs when the tendons around the base of the thumb are irritated, inflamed or constricted. The word “tenosynovitis” refers to swelling of the tendon sheath. Thickening of the tendon sheath that covers two of the tendons responsible for moving the thumb can cause pain and tenderness along the thumb side of the wrist. Patients who have De Quervain’s Tenosynovitis often experience pain when lifting the thumb, forming a fist, grasping or gripping things, or when turning the wrist.

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SYMPTOMS

  • Pain along the thumb side of the forearm, near the wrist is common.
  • Difficulty and pain moving your thumb and wrist when doing activities that involve grasping or pinching.
  • Weakness in the hand and thumb.
  • A “sticking” or “stop-and-go” sensation in your thumb when trying to move it.

DIAGNOSIS

De Quervain’s Tenosynovitis can often be detected by Finkelstein’s test, which requires the patient to clasp the affected hand in a fist, with the thumb enclosed; then moving the wrist down, in the direction of the little finger.

This test is usually quite painful compared to the uninjured hand/wrist. There may also be tenderness with pressure applied directly over the tendon.

Diagnosis can also be confirmed with an ultrasound which can detect if there is any local inflammation.

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(Finkelstein’s test for De Quervain’s Tenosynovitis)

NON-SURGICAL MANAGEMENT

  • Splints – to provide rest and immobilisation of the inflamed tendons of the thumb. These splints can be hard and custom made by your therapist (thermoplastic thumb spica) or semi-rigid (neoprene + thermoplastic).Untitled15  Untitled16
  • Heat/ice
  • Anti-inflammatory medication
  • Ultrasound
  • Wrist stretches
  • Advice on returning to work (eg. taking frequent rest breaks during repetitive tasks, keeping wrist in neutral alignment when possible).
  • Adapting manual repetitive work activities which aggravate the pain
  • Addressing postural issues and muscle imbalances
  • Progression to a strengthening program once pain and inflammation is reduced

SURGICAL MANAGEMENT

Surgery may be recommended if symptoms of De Quervain’s Tenosynovitis are severe or do not subside after total rest for approximately six weeks. The goal of surgery is to release the tendons and give them more space so they no longer rub on the inside of the tunnel.

Therapy is also beneficial post surgery to optimise normal functional use of the hand, restore full range of motion and to increase strength.