Articles De Quervain’s Tenosynovitis

August 6, 2019

This article explains what De Quervain’s Tenosynovitis is, causes, symptoms, risk factors, diagnosis and physiotherapy management.

Basic Anatomy

Your tendons connect your muscles to your bones.  At the base of your thumb are the tendons which enable you open and extend your thumb.

Tendons of the Thumb


Surrounding these tendons is a slippery covering called the synovium. These structures travel underneath a fibrous tunnel called the tendon sheath which holds everything in place. 

What is De Quervain’s Tenosynovitis?

In normal circumstances the thumb tendons glide freely as they pass underneath the tendon sheath. Thickening of the thumb tendons and/or tendon sheath results in narrowing of the tunnel. Friction between these structures give rise to inflammation and pain, this is know as De Quervain’s Tenosynovitis. 

De Quervain’s Tenosynovitis

Causes

  • Overuse, repetitive use of the hands (i.e. gripping, pinching, lifting and squeezing) over prolonged periods of time give rise to micro trauma and over loading of the bodies tissues. 
Repeated use of the hands often gives rise to De Quervain’s Tenosynovitis
  • Trauma, excessive scarring following trauma (i.e. fracture, laceration) can result in thickening of the tendon and/or tendon sheath.
Thumb Fracture
  • Pregnancy, this condition commonly occurs during and after pregnancy. This due to a combination of hormonal changes (causing fluid retention) and overuse from nursing a new born (i.e. breast feeding, carrying).
  • Inflammatory Arthritic Conditions, conditions such as rheumatoid arthritis cause wide spread inflammation of the joints through out your body.  This often affects the wrist and hands giving rise to De Quervain’s Tenosynovitis. 

Symptoms 

  • pain  and swelling over the base of the thumb and thumb side of the forearm
  • pain with thumb, wrist and hands movements 
  • snapping sensation when moving thumb
  • weakness with gripping 

Diagnosis

Diagnosing this condition is mainly based on an individual’s clinical presentation through a thorough subjective and physical examination (a quick diagnostic test has been detailed below). An xray or ultrasound may also be required to exclude/identify other injuries.

Quick Diagnostic Test

Risk  Factors

  • engaging in occupations, sports and activities involving repetitive gripping 
  • 30-50 years of age 
  • pregnancy
  • female gender 
  • typically affects dominant hand 
Occupations involving repetitive use of your hands increase your risk of developing De Quervain’s Tenosynovitis

Management

This condition is typically managed with conservative physiotherapy treatment. Oral/topical anti inflammatory medications may also be used to alleviate excessive inflammation. For more persistent symptoms, a localised steroid injection may be required.

In rare circumstances where your symptoms are severe and not improving after >6 months of conservative treatment, surgical intervention may be required to release the tendons. 

Anti inflammatory medications can help alleviate inflammation

Physiotherapy Management 

  1. Following an acute injury our priority is to minimise the extent of damage, reduce inflammation and decrease pain. Modalities such as RICE (Rest, Ice, Compression, Elevation), strapping, splinting and manual therapy may be used
  2. Provide education, address unhelpful beliefs regarding the injury, identify and modify aggravating factors (i.e. poor wrist posture, lifting techniques)
  3. Restore pain free wrist and thumb range of motion 
  4. Strengthen the muscles of the thumb, wrist and upper limbs
  5. Identify and address movement and postural issues that may have contributed to the injury (i.e. stooped posture, poor positioning of the shoulder blades)
  6. Graded return to work, sport and function
Immobilising the thumb with a splint can help to alleviate pain and prevent further aggravations

Please keep in mind the information provided is general in nature and should not be used as a substitute to consult your treating health professional. If you have any specific questions or require assistance with your individual treatment requirements please do not hesitate to contact My Family Physio, Pittwater Place Shopping Centre, Mona Vale.   

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