De Quervain’s Tenosynovitis
De Quervain’s tendinopathy is a mouthful of a condition that causes pain along the thumb side of the wrist, swelling, decreased grip strength, and restricted thumb movements.
It inflames the sheath (the synovium) that surrounds the two tendons that are involved in moving your thumb and can be very painful if left untreated.
What causes Tenosynovitis?
In 1892, the 13th edition of Gray’s Anatomy first described this tenosynovitis as “wrist sprain of washerwomen”. A Swiss surgeon, Fritz de Quervain went further in 1895 and published a report on five cases of first dorsal compartment tenosynovitis and the condition has taken his name ever since.
While the exact causes are long and debated, repetitive activities requiring sideways movement of the wrist while gripping the thumb and modern handheld electronics have been shown to cause De Quervain’s tenosynovitis.
Who is most at risk?
De Quervain’s tenosynovitis occurs most often in individuals between 30 and 50 years of age and is at least 5 times more common in women. It commonly occurs in mothers with young infants due to a combination of overuse and hormone-related tendon swelling, and those in sports and jobs with repetitive movements.
What are the signs and symptoms?
Symptoms are typically of gradual onset, but may develop suddenly and pain located over the thumb side of the wrist, radiating up to the forearm and swelling is common. It is worse with use of the hand and thumb, especially forceful grasping, pinching and twisting. There may be swelling at the site of pain and “snapping” when the thumb is moved. Due to pain and swelling, thumb movement may be reduced.
How is De Quervain’s tenosynovitis diagnosed?
The Finkelstein test is a simple way physiotherapists diagnose De Quervain’s. It is performed by placing your thumb down into the palm of the same hand, making a fist around it and then bending the wrist towards your little finger. If this exacerbates the pain at the base of your thumb, this is considered a positive test and likely that you have De Quervain’s. X-rays are not usually required for diagnosis.
What is the treatment for De Quervain’s?
Injuries of the hand and thumb can be challenging, since we use them in our daily lives, healing time can take a little longer. Typical physical therapy management of de Quervain’s disease and other wrist disorders consists of:
Rest – As best as possible, try and limit the movements that aggravate symptoms and give it some time to settle down
Splinting – An off the shelf or custom made splint can help your thumb to rest by limiting its movement
Physiotherapy for De Quervain’s
First of all, your Fixio physio is going to check the way you do your work or sports tasks to try to reduce or eliminate the irritation on the thumb tendons. Your physiotherapist may suggest alternative techniques or ways of doing things to ensure healthy body alignment and wrist positions. Part of your bespoke rehab plan for De Quervain’s tenosynovitis supports helpful exercises, and tips on how to prevent future flare-ups.
As you progress, you’ll begin doing active movements and range-of-motion exercises as your physio gives you at-home exercises to help strengthen and stabilise the muscles and joints in the hand and thumb.
For specific advice regarding your wrist pain, please consult your Fixio Physiotherapist. We can create your personalised recovery plan straight away and get you back to doing the things you love, pain free.