Hand & Wrist - De Quervains Tenosynovitis

Hand & Wrist - De Quervains Tenosynovitis

Healing Your Thumb: A Comprehensive Guide to De Quervain's Syndrome

De Quervain's Tenosynovitis is a painful condition affecting the tendons on the thumb side of your wrist and makes it difficult to perform everyday tasks that require gripping or pinching. 

It occurs when the two tendons that control movement of the thumb become irritated or inflamed. These tendons run through a narrow tunnel at the base of the thumb and when irritated cause pain and swelling.

Who is at Risk and Why?

De Quervain's Tenosynovitis commonly affects people who do repetitive hand or wrist movements especially between the ages of 30 and 50 years old. 

‘At Risk’ Activities include gardening, playing racquet sports, young parents (particularly young mothers due to frequent lifting) lifting a baby, knitting, playing musical instruments or even excessive smartphone use.

Gripping, pinching or twisting tends to make the condition worse. 

There are other factors that can put you at risk, such as a direct injury to your wrist, inflammatory conditions (such as Rheumatoid Arthritis) and hormonal changes that accompany a pregnancy. 

Women are more likely than men to develop De Quervain's Tenosynovitis, potentially due to anatomical differences and activities associated with child-rearing (new mothers).

There are a number of things that can act as triggers, including repetitive thumb and wrist movements, direct injury to the wrist, or prolonged gripping. 

Signs and Symptoms

• Pain and tenderness at the base of the thumb

• Swelling near the base of the thumb

• Difficulty moving the thumb and wrist when performing activities that involve grasping or pinching

• A "sticking" or "stop-and-go" sensation in the thumb when moving it

Symptoms often worsen with continued use of the thumb and wrist and can make it challenging to perform daily tasks.

Complications if Untreated

• Chronic pain and reduced thumb and wrist mobility.  

• Significantly impacts your ability to perform everyday activities like writing, cooking, or even holding objects 

Early intervention is crucial to prevent long-term complications and restore normal hand function.

Assessment Techniques

• We will review your medical history and your symptoms, then perform a thorough examination and then we will do some specific tests to check how you react to them.  

• The most common test is where you make a fist with your thumb inside the fingers and the wrist is gently moved towards the little finger. Pain during this movement typically indicates De Quervain's Tenosynovitis.

Physiotherapy Treatment Options

The focus is on reducing inflammation, relieving pain, and restoring normal function.

1) Manual therapy techniques: At Chester’s Best Physiotherapy Clinic for treating hand injuries, we take this very seriously.  Using soft tissue manipulation and mobilisation we can reduce pain and inflammation. This helps to improve blood flow, reduce swelling, and alleviate tension in the affected tendons.

2) Other Treatment Techniques: Ultrasound Therapy, TENS (Transcutaneous Electrical Nerve Stimulation), and Ice Therapy are used to reduce pain and inflammation. Ultrasound Therapy uses sound waves to promote tissue healing, while TENS provides electrical stimulation to block pain signals. Ice Therapy helps to reduce swelling and numb the affected area. 

3) Patient Education and Self-Management: Physiotherapists provide guidance on activity modification, home exercise programs, and self-care techniques. By understanding their condition and learning how to manage it, patients can take an active role in their recovery and prevent the issue from getting worse.

4) Exercise Therapy: Includes gentle stretching and strengthening exercises for the wrist and thumb. Stretching exercises help to improve flexibility and reduce tightness in the tendons, while strengthening exercises support the muscles around the thumb and wrist, promoting better function and stability.

5) Ergonomic Education: This is vital to make sure that any problems do not reoccur.  Your friendly Relive Physiotherapist can provide guidance on proper hand and wrist positioning, as well as recommendations for modifying activities to reduce strain on the thumb and wrist. This may include using adaptive tools or adjusting workstations to promote better ergonomics.

6) Splinting: This involves using a thumb splint to immobilise the thumb and wrist. The splint helps to reduce movement and provides rest to the affected tendons, allowing for healing and reducing pain. Splints are often worn during daily activities or at night to provide continuous support.

In cases where Physiotherapy alone is insufficient, additional treatments may be considered. Corticosteroid injections can help reduce inflammation and provide quick pain relief. It is often considered as the best course of action if you needed a faster recovery. We would recommend you to seek advice from our Specialist Chartered Physiotherapists who does these injections. 

Surgical intervention may be necessary to release the tendons and provide long-term relief. Surgery is typically considered when conservative treatments have failed, and symptoms are severe.

Conclusion

In short, De Quervain's Syndrome, while painful, is manageable with timely intervention from a Physiotherapist. Understanding the condition and seeking appropriate treatment can help you regain their quality of life.

Happy recovery!