De Quervain’s tenosynovitis
Pain at the base of the thumb? You may have De Quervain’s Tenosynovitis!
What is De Quervain’s Tenosynovitis? What causes of De Quervain’s Tenosynovitis? Risk Factors of De Quervain’s Tenosynovitis? How to Diagnose of de Quervain’s tenosynovitis? Treatment of de Quervain’s Tenosynovitis? Non-surgical treatments options for de Quervain’s Tenosynovitis. This article we answer all of your questions about de Quervain’s Tenosynovitis.
What is De Quervain’s Tenosynovitis?
De Quervain’s tenosynovitis is a condition of the thumb and wrist commonly associated with pain below where your thumb joint meets your wrist joint. There are two tendons (extensor pollicus longus and extensor pollicus brevis) that straighten your thumb into a ‘thumbs up’ by travelling together on the back of your thumb through a ‘tunnel’. The pain is due to a break down of collagen in this area, which can lead to thickening of the tendons, the ‘tunnel’ or both. This causes difficulty and pain to glide the tendons through the ‘tunnel’. Clinical assessment and/or ultrasound imaging can usually diagnose De Quervain’s.
Causes of De Quervain’s Tenosynovitis?
Causes for De Quervain’s Tenosynovitis include the following:
- Repetitive hand and thumb activities such as grasping, pinching, squeezing or wringing may lead to inflammation of tenosynovitis. Swelling could then occur, which limits the smooth gliding action of the tendons within the tunnel.
- Arthritic disease such as rheumatoid arthritis, can also causes tenosynovitis in the thumb
- Injuries can form scar tissues that can make it difficult for the tendons to slide easily through the tunnel
- In some cases, symptoms may present after no direct mechanism
Speak our chiropractor if you’re suffering from the symptoms as mentioned below and have any of the aforementioned causes.
Risk Factors of De Quervain’s Tenosynovitis
Risk factors for De Quervain’s Tenosynovitis include the following:
- Patients between the ages of 30 and 50 are more at risk of developing this condition than other age groups particularly children
- Women are found to be affected more than men
- Pregnancy. Studies have shown a possible correlation between pregnancy and this condition, although the reason for this is not fully understood
- Jobs, hobbies, and vocations that require repetitive hand and wrist motion and regular pressure or strain on the wrist
Do you think you’re at high risk of developing De Quervain’s tenosynovitis? Speak to our chiropractor to see how you can reduce your risk and modify your activities to prevent development of De Quervain’s tenosynovitis.
Symptoms of De Quervain’s Tenosynovitis?
Symptoms of De Quervain’s Tenosynovitis include the following:
- Pain, tenderness and/or swelling between your wrist and thumb on the back of your hand
- Difficulty and pain moving your thumb and/or wrist
If you think you may be suffering from De Quervain’s tenosynovitis we recommend getting assessed by our chiropractor or physiotherapist.
How to diagnosis of de Quervain’s tenosynovitis?
The diagnosis of de Quervain’s tenosynovitits is quite simple. It does not require any imaging to confirm findings.
The Finklestein test is one of the most accurate and reliable tests to make the diagnosis. To try this yourself, follow these steps;
- Bend your thumb into the palm and grasp the thumb with your fingers making a fist with the thumb inside.
- Bend your wrist away from your thumb in a side-to-side motion.
- If you feel pain over the tendons to the thumb as shown in the image, your problem is probably de Quervain’s tenosynovitis.
Treatment of de Quervain’s Tenosynovitis?
It is recommended that non-surgical treatment of De Quervain’s is initially trailed. The following treatments are a guide. Your chiropractor, physiotherapist or osteopath will recommend those, which are appropriate for you.
Non-surgical treatments options for de Quervain’s Tenosynovitis:
Typically, tasks that aggravate symptoms include repetitive, and/or resistive hand activities as well as tight gripping and side to side wrist movements with your thumb out eg. Twisting off a lid, peeling potatoes, and lifting your baby. Avoiding activities that aggravate your pain is best.
Changing the way you perform activities may reduced your pain. If you have any specific tasks that are difficult and cause pain, talk to your therapist about specific strategies. Your therapist may also provide information on helpful websites and organisation with regard to activity modification strategies.
Some activity modification examples that you may find helpful are:
- Using your unaffected hand where possible
- Avoiding using your thumb to grasp objects. Try and use your whole hand
- Prioritise tasks that need to be done and try to delay those which are not important
Adjustments / Mobilisation / Soft tissue massage
It is important to look at the joints and muscles above and below the area of pain to see if the source of the pain is coming from another area of dysfunction. Your chiro, osteo or physio will assess and address these areas through adjustments, mobilisations and soft tissue massage as required.
To prevent stiffness of your joint and encourage tendon healing, gentle and pain free movements are important. Your therapist will recommend an exercises program specific for your symptoms.
There are a variety of splints that
may help to reduce your symptoms. Your therapist will
recommend the most appropriate splint, if it is necessary.
Other Non-surgical treatment
In cases where symptoms are more severe, you may be referred to discuss with your doctor about anti-inflammatory medications (NSAIDS) or corticosteroid injections to help manage your symptoms in addition to hand therapy.
What if non-surgical treatment does not help?
Surgery for De Quervain’s tenosynovitis may be recommended by a specialist if the condition is more severe; the above treatment have proved ineffective; or if a patient has had one or more recurrences of De Quervain’s Tenosynovitis.
How long until De Quervain’s gets better?
Your recovery from De Quervain’s is dependent on your compliance to your health professional’s advice. Avoiding repetitive actions and positions is key, using braces/splints as prescribed and performing tailored exercises regularly are all important to see your symptoms improve. Typically, should see significant improvements by 6 to 12 weeks.
In some severe cases of De Quervain’s, which do not respond to conservative treatments, surgery may be required. Following surgery, patients will be referred for 6 to 8 weeks for physical therapy to learn stretches and exercises that can restore range of motion, dexterity, and strength for the hand and fingers.