De Quervain’s Tenosynovitis
What is De Quervain’s Tenosynovitis?
De Quervain’s is a painful inflammatory condition of the tendon sheath on the thumb side of the wrist. This will occur when there is a thickening and irritation of the tendon sheath. The thickening then restricts smooth tendon gliding, resulting in pain with thumb and wrist movement.
Anatomical Structures Involved
The first dorsal extensor compartment of the wrist is impacted by this condition. Within the first dorsal compartment sits the Abductor Pollicis Longus (APL) and Extensor Pollicis Brevis (EPB), which are responsible for thumb and wrist movements (thumb abduction and extension, and wrist radial deviation) Other structures involved include the fibro-osseous tunnel (tendon sheath), radial styloid process (common site of pain), and the superficial radial nerve (can become irritated)
What can cause De Quervain’s?
This can be caused due to repetitive strain rather than acute trauma to the area. Repetitive thumb abduction/extension, repeated wrist radial deviation, lifting with thumb extended (e.g., new parents lifting babies, prolonged phone use/texting, manual labor, or sports (golf, tennis, or weight training) can increase the risk of developing De Quervain’s. Other risk factors include can include pregnancy and postpartum period, inflammatory conditions (e.g., rheumatoid arthritis), or poor wrist/thumb mechanics
What are the symptoms of De Quervain’s?
- Pain over the radial (thumb) side of the wrist
- Pain worsens with gripping, pinching, twisting
- Swelling near the radial styloid
- Clicking or catching sensation
- Weak grip and pinch strength
How is De Quervain’sdiagnosed?
A clinical exam performed by a physician is usually sufficient. Use of an ultrasound can show tendon sheath thickening. An MRI is rarely needed unless the diagnosis is unclear.
What are the treatment options for De Quervain’s
Typically, conservative treatment is sufficient for most cases. This includes the use of activity modifications, immobilization and protection of the thumb and wrist by splint, and hand therapy. In some situations, your physician may suggest a Corticosteroid Injection to the area. This can be effective for many patients and will usually be done in combination with splinting. A person may require 1–2 injections. Only three cortisone injections are typically given in a lifetime in the same area; therefore, the first line of defense is therapy. If symptoms persist after conservative treatment or there is severe tendon entrapment, surgery may be required to release of the first dorsal compartment
What is the rehabilitation of De Quervain’s?
Phase 1 (settle inflammation) would include splint use, activity modification to avoid painful motions, and gentle pain-free thumb movements. Your doctor may give you a splint or refer you to a Certifed Hand Therapist (CHT) for a custom orthotic. In phase 2 (mobility), gentle thumb motion will be initiated, as well as tendon gliding exercises, and wrist mobility. Phase 3 (strengthening) is classified by using isometric thumb exercises, gradual grip strengthening, and emphasis on neutral wrist posture. Lastly, in phase 4 (return to activity), the individual will complete progressive loading of the impacted hand and thumb, ergonomic corrections, and completion of sport/work-specific drills.
The rehabilitation process and timeline will vary based on multiple factors such as instability, delayed healing, or other guidelines from the surgeon. It is important that you see a therapist that specializes in Orthopedic care of the Upper Extremity such as a Certified Hand Therapist, to ensure proper progression through the rehab process to avoid re-injury.
