De Quervain’s Tenosynovitis is an overuse condition of the membrane (tendon sheath) that surrounds the tendons responsible for the action of the thumb. It is characterised by pain and inflammation in the area where the wrist and thumb articulate.
De Quervain’s presents with pain during activities that place load through the affected tendon and sheath such as lifting, pinching and gripping. Pain and swelling is typically localised to the region where the wrist and thumb converge, looking at the hand in a ‘thumb’s up’ position. Patients may also present with a reduced range of motion in the affected thumb and you may experience a ‘catching’ sensation with the thumb in certain positions. 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.
This condition typically develops from gradual or sudden overload of the tendon sheath which works over the wrist and thumb. Over time, certain actions repeated over and over can irritate the sheath that surrounds the tendons of the thumb. 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.
Although De Quervain’s typically arises from long-term overuse, direct trauma may also lead to pain and swelling with scar tissue formation.
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. This comprehensive examination will facilitate a quick and decisive diagnosis which will mean treatment can begin straight away for the best outcomes to be achieved.
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. We advise consulting with your Physiotherapist prior to trying any of these exercises.
Regular re-assessment will ensure you are making progress and that your management and exercise plan remains optimal for producing favourable outcomes. We will work closely with you and will have your personal goals at the forefront of your treatment. We provide ongoing support and progressive exercises so that you can effectively manage your symptoms and prevent re-occurrence.