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DEQUERVAIN'S TENOSYNOVITIS

DeQuervain’s is pain on the thumb side of the wrist, about where a watch would rest. It is associated with movement of the wrist or thumb. You will normally notice the pain when you lift up a baby, reach out to grab something with an open thumb or lift the thumb up and down repeatedly. You can also notice pain in positions where your wrist is bent forward and towards the little finger side of your hand. Side-to-side movement of the wrist is another common movement that will cause symptoms. The pain will be even worse if you are holding something heavy or doing something requiring force.

What causes DeQuervain’s?

DeQuervain’s is very common in new parents. This is due to holding and lifting a new baby with the thumbs up, combined with an up-and-down movement at the wrist and holding their baby on their hip for sustained periods. DeQuervain’s is also common in work that requires strong or repetitive thumb and wrist movements. Direct trauma such as falling on your wrist or thumb, a sudden twisting force in the area or a direct blow to the side of the wrist can also cause DeQuervain’s.

You can easily see the tendons affected by DeQuervain’s when you do a thumbs-up sign with your hand. These tendons help to lift the thumb up and out. They’re held down onto the bone at the level of the wrist by a strong pulley, or sheath. The pain of DeQuervain’s is due to a thickening of the sheath, which causes a tightening over or compression of the tendons, and sometimes swelling in the area. This makes movement of the tendon painful.

 

How do I know if I have DeQuervain’s?

DeQuervain’s will often become apparent due to pain and swelling over the thumb side of the wrist. The pain will sometimes travel down into the thumb or up into the forearm.

If lifting your thumb is difficult or painful, or if bending it down towards your little finger hurts, you could have DeQuervain’s. Other conditions that occur around this area may have similar symptoms, but different causes and treatment. Your physiotherapist or hand therapist will help you to diagnose this.

If the swelling is large enough, you might feel sensations of clicking, flicking, catching or locking in your wrist. Sometimes these are pain-free and are the only sign of DeQuervain’s that you’ve noticed.

 

How can physiotherapy help with DeQuervain’s?

Splinting 

Your physiotherapist or hand therapist will make you a splint to greatly reduce the movement of the thumb tendons. This splint will need to hold the wrist and part of the thumb still, but you will still be able to do everything you need to do with the splint on. The splint will be required for up to six weeks.

Education on activity modification 

Simple adjustments to your activities can be very helpful, like changing the wrist and thumb position you use when you’re lifting things or avoiding static holding positions of the thumb and wrist that are painful. There are many things a physiotherapist can show you that will reduce the pain.

Exercises

Rehabilitation exercises of the thumb tendons will help reduce the pain and also strengthen the area. Regular exercises are known to be a vital part of treatment and are important to help prevent a recurrence of the condition. Generalised strengthening of the shoulders and elbows can also place less load at your wrist, helping long-term recovery.

Massage and other soft tissue techniques 

Soft tissue techniques to relax the muscles may be incorporated into treatment sessions with your physiotherapist to help reduce the tension in the muscle/tendon unit. This can help the other treatments outlined here.

 

How effective is physiotherapy for DeQuervains?

People with DeQuervain’s can expect a full recovery most of the time, especially with splinting and activity modification. The treatments listed above may need to be combined with a cortisone injection from a doctor or specialist for full recovery. In a small number of cases, splinting and cortisone will not be enough to fully resolve the symptoms and surgery may be needed to release the tendon sheath.

 

What can I do at home?

  • Wear your splint as much as possible, even in bed at night. Be sure to continue to use your hand in the splint for any activities that don’t hurt. But, it’s important that you avoid painful activities for the period of time your physiotherapist has advised.
  • Follow your physiotherapist’s advice on avoiding the positions and movements that are aggravating the condition. When you are lifting your baby, you can try to keep the wrist in a straight position with the thumbs by the side of your hand, lifting them up in a scooping type of motion.
  • Avoid pressing with your thumb as much as possible, try using pull on baby pants instead of grow suits with press studs.
  • You will also have specific exercises to complete at home when appropriate. It is important that you do these as guided by your physiotherapist to make sure you regain full movement and strength.
 

How long until I feel better?

You will be able to do a lot more with reduced pain as soon as you are fitted with the right splint.

Your recovery time will depend on the severity of your DeQuervain’s and how long you have had it before seeking treatment. Splints will be needed for 2–6 weeks, followed by a period of rehabilitation to regain full movement and strength of the tendons.

 

Source: Choose.physio