What is it?
De Quervain’s Tenosynovitis is a painful condition involving inflammation of the tendon sheath for 2 of the thumb tendons. The tendon sheath is designed to lubricate the movement of the tendon along the side of the thumb. In certain situations, usually involving repetitive wrist movements, with sustained gripping or use of the wrist and hand in poor positions, the sheath itself becomes inflamed and irritated. This will tend to result in pain and stiffness in the base of the thumb with repetitive or prolonged use of the thumb and hand. It is a very common condition in new Mums due to the volume of lifting and carrying of the new bub.
Risk Factors
Several risk factors for De Quervain’s Tenosynovitis have been identified and include:
- Aged between 30 – 50.
- Repetitive wrist, hand, and thumb movements.
- Females more commonly develop De Quervain’s Tenosynovitis.
- Being pregnant or parent of young infant.
- Individuals who have inflammatory conditions.
Diagnosis
Diagnosis of De Quervain’s Tenosynovitis by an experienced Physiotherapist is quite straight forward and will involve:
- Subjective history to identify the pattern of the pain.
- History of recent training loads, and activities that involve the wrist, hand, and thumb.
- Medical history, including inflammatory health conditions.
- Palpation of the base of the thumb, wrist and tendon reproduces pain.
- Tests designed to load the tendon and sheath of the Extensor Pollicis Brevis and Abductor Pollicis Longus.
Imaging is generally unnecessary for accurate diagnosis.
Management
Management of De Quervain’s Tenosynovitis includes:
- Education around the injury, causes and management of the tendons.
- Activity modification to reduce load such as decreasing triggering activities where possible.
- Provision of a brace is often useful to offload the thumb in manual handling tasks.
- Use of ice and anti-inflammatory medications are often helpful.
- Manual therapy if indicated from the physical examination.
- Graded loading and mobility of the wrist, hand, and thumb complexes.
- In severe cases an injection of cortico steroid may be considered.
De Quervain’s Tenosynovitis is a common and often disabling condition. While decreasing provocative loads is not always easy, adherence to a simple program with the appropriate offload and support will generally yield quite good outcomes.
If you think you are suffering with De Quervain’s Tenosynovitis, or another hand injury, book now with one of our experienced physiotherapists to create a plan to get you back In Balance and doing the things you love!
