De Quervain’s Tenosynovitis
Treating De Quervain’s Tenosynovitis
by ACE Physical Therapy and Sports Medicine Institute
Tips for De Quervain’s Tenosynovitis.
- De Quervain’s Tenosynovitis symptoms can include pain, catching and decreased grip strength.
- Treat this and all tenosynovitis pain with the principles of acute injury care of RICE (Rest, Ice, Compression, and Elevation).
- Wearing a splint that limits the motion of the thumb is usually part of the treatment protocol.
- In many instances, the symptoms will not resolve until an injection of cortisone is administered.
- Seek the advice and guidance of your Physical Therapist to address and treat the symptoms associated with De Quervain’s Tenosynovitis.
De Quervain’s Tenosynovitis is a condition of pain and swelling on the back of thumb and stretching down along the wrist. People suffering from this disorder may experience a continual ache that inflames when the thumb is used to grip or lift. While the specific causes are not clear, there are treatment options that can help reduce pain and swelling.
What is De Quervain’s Tenosynovitis?
De Quervain’s is an inflammation of the tendons or tendon sheaths of the muscle tendons that course along the thumb side of the wrist and insert into the backside of the thumb. Muscles are attached to the bone via a tendon. The tendon is leather like in consistency and has a smooth silk sheath surrounding it. The sheath is synovium, which produces fluid and acts as a tunnel that enables the tendon to “glide” or “slide” through it.
If the sheath or tendons on the back of the thumb are injured, a person can suffer from De Quervain’s Tenosynovitis. There are three tendons located in this area (Extensor Pollicis Longus, Extensor Pollicis Brevis and Abductor Pollicis Longus). If one or all three are injured through overuse or the trauma of blunt force, symptoms resembling De Quervain’s Tenosynovitis will result.
De Quervain’s Tenosynovitis has become known in the medical world as Constrictive Tenosynovitis of the First Dorsal Compartment. This change in nomenclature occurred because it more clearly defines the exact anatomical location of the injury and the simple fact that healthcare professionals had a difficult time spelling and saying De Quervain’s.
Symptoms of De Quervain’s Tenosynovitis
This condition feels like dull to sharp pain at the back of the thumb (posterior/dorsal) and it may extend down to wrist. These tendons are very sore to the touch (palpation) and exhibit a great deal of pain when they actively contract to move the thumb into an extended or abducted position. Symptoms can also include a “clicking or catching” sensation in the area of the tendons where they cross from the thumb to the wrist.
While there is no known cause for the condition, it frequently occurs in new mothers who have been required to constantly pick up their newborn child. The condition occurs in women in greater frequency than men and usually in women that are between the ages of 30 – 50 years old. Lifting any thing heavy repeatedly or working with your hands at tasks that require a forceful grip can cause symptoms. An aching symptom is constant, but when the thumb is used actively the pain level rises as the condition worsens.
Diagnosis and Treatment
A healthcare professional can help identify and recommend treatment. Finkelstein’s maneuver is used to test for De Quervain’s Tenosynovitis. This test is done with the patient holding their thumb in the palm of their hand with the other fingers (“making a fist with the thumb wrapped by the fingers) and extending the arm fully at the elbow and the thumb pointing towards the ceiling.
The healthcare professional then tilts the patient’s wrist in a manner that moves the little finger towards the floor. The patient can perform this movement actively and produce the same or similar results. If the pain level rises significantly there is a positive diagnosis for De Quervain’s Tenosynovitis.
Treatment is similar to any type of Tenosynovitis:
Rest – There should be a period of rest (splints work well, but inhibit the use of the thumb and compliance is not always great because a new mother cannot discontinue using her involved thumb), a period of “active” rest which is gentle, relatively painless movements of the thumb into all motions including the directions that caused pain in the first place.
Ice – Icing is a must and over-the-counter-anti-inflammatory medications can help reduce the intensity of the symptoms quickly.
Medication – If this does not eliminate the symptoms a doctor might prescribe a stronger non-steroidal anti-inflammatory medication and/or inject a steroid such as cortisone to control the inflammatory process.
Stretching and Resistance Training – Exercises should be performed to stretch the involved tendons. The test position (Finkelstein’s test) can be used to stretch the tendons. Intense stretching can cause more pain and injure the tendons further; therefore frequent low intensity stretching is more advantageous. Low resistance and high repetition strengthening exercises can be used to increase blood flow into the damaged tendons and help the healing process.
Surgery – Very infrequently, surgery is performed to “release” the tendon sheath and allow the tendon to glide more easily.
De Quervain’s Tenosynovitis is common in people who use their hands repeatedly and have to grasp forcefully with the thumb. The symptoms include pain, “catching” and weakness of the thumb and grip. The symptoms can be resolved with the use of gentle exercise, rest, medication to reduce the inflammation and ice. Seek the advice of treatment from your Physical Therapist and they can guide your rehabilitation efforts.
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