De Quervain’s Tenosynovitis
What Is it?
De Quervain’s Tenosynovitis (also referred to as radial styloid tenosynovitis) is a painful condition affecting the tendons on the thumb side of the wrist. The condition is defined as inflammation of the synovium of the abductor pollicis longus and extensor pollicis brevis tendons as they pass at the level of the radial styloid of the wrist.
The main symptoms of De Quervain’s include pain and tenderness in the wrist, below the base of the thumb. In severe cases swelling or crepitus may be present.
The pain is often felt after repeated movements of the wrist and thumb. The pain may be accompanied by local stiffness and may commence after a period of rest.
The largest risk factor for developing de Quervain’s includes tasks with repetitive wrist movements often involving the thumb. Often these movements include extension or abduction (side motion) of the thumb with or without resistance.
It is a highly prevalent condition in racquet sports, ten pin bowlers, rowers and canoeists given the position of the thumb whilst gripping. Professions that require hand dexterity such as baristas and chefs often have this condition . It can also be identified in those with excessive mobile phone or tablet use due to the repetitive thumb motions whilst texting and scrolling.
De Quervain’s Tenosynovitis is medically diagnosed often by a physiotherapist or general practitioner.
The clinician will assess the range of motion of both the thumb and wrist. A strength and grip assessment will also be conducted to highlight any differences between the symptomatic and unaffected side, and as a comparison to dominate limb function.
Palpation may reveal localised pain and tenderness over the abductor pollicis longus and/or extensor pollicis brevis tendons.
A positive Finkelsteins test is a highly diagnostic test as it compromises the affected soft tissues as they pass through the wrist.
In rare cases, ultrasound or MRI investigation are utilised in the diagnosis of the condition.
Multiple interventions can be utilised in the treatment of de Quervain’s tenosynovitis. As the condition can become chronic and often debilitating, treatment is most successful when commenced early.
Your physiotherapist will guide the appropriate management based on your assessment findings and the severity of symptoms which may include:
– Rest from aggravating exercises
– Anti-inflammatories if advised by a doctor
– Graduated strengthening exercises (starting with static contractions and building through range with resistance)
– Taping or Splinting of the thumb
– Injection of corticosteroid and local anaesthetic in tendon sheath
– in rare and severe cases surgery may be necessary
Blog by Christian Bonello (Physiotherapist)