What is De Quervain Tenosynovitis?
De Quervain’s tenosynovitis is a painful and inflammatory condition caused by tendons (mainly the extensor pollicis brevis and the abductor pollicis longus) on the side of the wrist at the base of the thumb. Males are rarely affected by this condition, which primarily affects women over 40. If left untreated, it may become chronic.
What causes the De Quervain syndrome?
Chronic overuse injuries to the tendons and tendon sheaths can occur in people, who use their thumbs repeatedly for activities such as gripping, grasping, golfing, playing the piano or other musical instrument, carpentry, kitchen activities, and continuous typing. De Quervain’s syndrome can develop as a result of other musculoskeletal conditions affecting the wrist and tendons. Direct wrist or tendon injury, as well as, hormonal changes during pregnancy and menopause are also major causes.
What are the signs and symptoms?
Signs and symptoms develop from mild to severe if kept untreated for prolonged time.
During acute phase
– Mild pain in rest
– Mild swelling at base of thumb
– Difficulty in movement of thumb and wrist
– Shooting or stabbing pain during thumb movements
– A sudden “stop and release” pattern of movement of thumb with pain
During chronic phase
– Severe pain on minimal movement
– Chronic inflammation and redness
– Malpositioning of the bone at the base of thumb at the joint.
How can someone examine and find out the condition?
Finkelstein’s test is the most widely used method of diagnosing De Quervain’s syndrome. This test is performed by first bending the thumb into the palm with wide open fingers of hand, then making a knuckle by placing the thumb inside the fingers and bending the wrist towards the little finger side; pain at the base of the thumb along with restriction in movement indicates a positive sign.
How can we treat this condition?
– Splinting or bracing: This immobilizes the joint, allowing for faster recovery and preventing further injury.
– Ice and Heat: Ice massage causes vasoconstriction, which pumps blood out of the area while also removing derbies and enhancing the healing process. Applying heat or hot packs around the wrist and thumb side will loosen tight soft tissues, and vasodilation caused by heat will increase blood flow in that specific area, allowing essential substances from the blood to reach the injured area sooner, resulting in faster healing.
– Non-steroidal anti-inflammatory drugs (NSAIDs), oral steroids, or corticosteroid injections are widely prescribed medications and have been found effective for faster recovery.
– Doing massage with analgesic gels/ointments to the affected area results in significant reductions in pain and inflammation.
– Preventing further injury to the tendons that can be caused by repetitive use of the thumb and hand is also the method of treatment.
– Another method of treatment is to prevent the tendons from being damaged by repetitive use of the thumb and hand.
– Surgery is done very rarely, and surgical prescription is only given if non-surgical management has failed and there is pain and inflammation limiting daily functional activities.. Post-operative care is also essential.
What are the effective exercises?
Always begin your exercise with a mild active stretch of the wrist and thumb in all directions with the assistance of another hand, followed by free movements of the wrist, thumb, and fingers. Regularly squeezing and releasing the exercise ball or smiley ball with the affected hand. Rotation of thumb and wrist in all directions without any resistance. When the pain and swelling starts to subside, hold the water bottle and support the forearm at the edge of the table and perform wrist movements repeatedly i.e, and flexion, extension, abduction, adduction, and rotation, and gradually increase the quantity of water to increase resistance. Stop if it aggravates the pain. Most importantly, use splint/brace during activities, and remove while sleeping.