De Quervain's Tenosynovitis: a common cause of thumb pain



What is De Quervain’s tenosynovitis?

De Quervain’s stenosis tenosynovitis is an overuse injury of the wrist and thumb involving two of the thumb tendons, Abductor Pollicis Longus and Extensor Pollicis Brevis. A tendon is a rope-like structure that connects a muscle to a bone. When the muscle contracts, it pulls on the tendon which makes the bone move. At the wrist level, the two tendons involved in De Quervain’s travel through a synovial sheath, which is a tunnel providing nutrition and lubrication to the tendon. Overuse of the thumb causes inflammation to the tendon and/or the sheath, limiting the size of the tunnel and leading to localized pain and, in some instances, clicking or a “sticky” feeling when moving the thumb.


Some of the risk factors for developing De Quervain’s are:

  • Pregnancy

  • Caring for a baby (frequently carrying/holding a baby)

  • Rheumatoid arthritis

  • Middle aged women

  • Jobs or hobbies involving repeated thumb and wrist movement: fencing, combat sports, racquet sports, gardening/landscaping, housekeeper, etc.


The main symptoms of De Quervain’s are:

  • Pain felt over the thumb side of the wrist which is worse during hand and wrist use. It can happen gradually or suddenly. Pain can radiate to the thumb and/or the forearm.

  • Burning sensation to the base of the thumb or wrist

  • Clicking or catching with thumb or wrist movement

  • Swelling over the thumb side of the wrist

  • Pain when making a fist, gripping items and with hammering motion


How to you diagnose De Quervain’s?

De Quervain’s stenosis tenosynovitis is a clinical diagnosis based on symptoms (pain, location, swelling) and provocative testing like the Finkelstein’s test. Your therapist will complete other tests as well to eliminate other possible diagnoses and ensure they find the right cause to your problem.


How to treat De Quervain’s?

Resolving the inflammation is the only way to heal De Quervain’s. Rest is therefore the first line of treatment and is best accomplished with a custom thumb and wrist orthosis to ensure that your tendons are immobilized in the best position to maximize rest. Dry needling or other forms of deep tissue release can also be used to relieve trigger points and decrease muscle tightness that could be contributing to the inflammation of the tendon. Finally, it’s important that you try to avoid any activities that aggravate your symptoms. The skilled eye of our occupational therapists/certified hand therapists comes in handy here to look at ways to modify your day-to-day activities to make them safe for your thumb. Come and see us for expert hand therapy in Edmonton!



 

References

  1. Lee M.P., Biafora S.J., Zelouf D.S (2021) Management of Hand and Wrist Tendinopathies. In T. M. Skirven (Ed.) Rehabilitation of the Hand and Upper Extremity (7th edition, Volume 1, 498-517) Philadelphia: Elsevier

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