De Quervain’s Tenosynovitis is characterised by pain and inflammation in the outer layer of the tendons which are responsible for the action of the thumb, typically presenting with swelling and a thickened region where the wrist and thumb articulate. This condition typically develops from gradual or sudden overload of the tendon sheath which work over the wrist and thumb such as lifting, pinching and gripping. Over time and as these actions are repeated over and over, the sheath becomes irritated, leading to pain and swelling.
Although De Quervain’s typically arises from long-term overuse, direct trauma may also lead to pain and swelling with scar tissue formation. Abduction of the thumb (thumb’s up position) is a commonly reported aggravator and grip strength decreases due to pain which can lead to reduced function. As repeated irritation is a critical driver in the development of this condition, continuation of gripping, pinching, grasping and wringing actions may increase the inflammation leading to more scar tissue formation and a worsening of symptoms.
Your Physiotherapist will take a detailed history followed by a thorough physical assessment to ensure the pain is not coming from any other structures in the area and may do some specific tests to ascertain if these tendons are the cause of the pain. Some of these may produce a small amount of discomfort which is normal and to be expected.
At Pure Physiotherapy, your clinician may suggest period of time to rest and offload the tendon sheath to help reduce irritation – a thumb and wrist ‘spica’ splint (as shown) is recommended.
Please note it is important to keep the thumb and tendon moving as immobilisation may lead to reduced function and restricted movement. Your Physiotherapist will provide advice for modifications of any tasks that are currently painful which will allow the tendon sheath to settle and begin to recover.
The affected tendons often benefit from strengthening to encourage new growth of collagen to make it more robust for the tasks that you require the thumb to complete. Your Physiotherapist at Pure will design and guide you through a tailored strengthening plan, instructing you on how many and how often to complete these exercises.
Please find the patient resources section of our website where we have recommended several exercises to maintain wrist and thumb movement. We also have a general thumb strengthening programme. To access these, please contact us to obtain the password. We advise consulting with your Physiotherapist prior to trying any of these exercises.