de Quervain’s Tenosynovitis
Updated: Mar 15, 2019
Hi Everyone, in this week’s blog we want to discuss a condition that specifically affects the thumb, known as de Quervains syndrome or Tenosynovitis.
de Quervains syndrome is an inflammation of the sheath or tunnel that surrounds two tendons, on the outside of the wrist, that control the movement of the thumb.
The specific structures involved include the Radius and Ulnar bones of the forearm, carpal, metacarpal and phalangeal bones of the hand along with the two inflamed muscles known as the Abductor Pollicis Longus (APL) and Extensor Pollicis Brevis (EPB).
These two muscles originate from the back side of the radius and ulnar of the forearm, both tendons run through their respective sheaths behind our anatomical ‘snuff box’.
They then run through a groove on the end of the radius before the EPB inserts into the base of the first phalanx (finger) and the APL into the base of the first metacarpal bone (in the hand).
The most common causes of de Quervains syndrome are chronic overuse of the thumb, followed by direct trauma and inflammatory arthritis. It is the repetitive use of the thumb in combination with radial deviation (bending the wrist towards the thumb side) of the wrist. In this position, the tendons of the EPB and the APL are pressed onto the bony end of the radius and when the movement is repeated frequently it can cause excessive friction and subsequent irritation of the tendons.
The sheaths then swell, and the tunnel becomes too small for the tendons which can result in a squeaking or crepitus noise on movement of the thumb and wrist.
de Quervains tenosynovitis is the most common radial sided tendinopathy and occurs particularly with activities such as golfing, playing the piano, fly fishing, carpentry, repetitive office work tasks, playing musical instruments and carrying a child.
Clients often present with local tenderness and swelling, which may extend proximally and distally along the course of the tendons. The pain is described as a constant ache, burning and/or a pulling sensation, and in advanced cases crepitus can be present. This pain is often aggravated by the above repetitive actions.
We diagnose de Quervain’s Tenosynovitis with a detailed subjective history, testing for movement restriction and strength deficits along with the presence of a positive Finkelstein’s Test.
The Finkelstein’s test deliberately places the APL and EPB under tension with the aim of eliciting a pain response over the area. However, this is also true for the radial nerve that runs through the anatomical snuff box and alone cannot be used to diagnose the presence of de Quervains tenosynovitis.
de Quervain’s syndrome can be, very well, managed with conservative treatment. A well-rounded plan consists, initially, of pain control, inflammation management and scar tissue mobilisation – this always correlates with a period of rest from the aggravating activity.
This is followed by restoring normal biomechanics to the wrist and thumb, focussing on the biomechanics of our repetitive movements to reduce the strain on the tendons and their sheaths.
The final step in any treatment plan is to strengthen the muscle group to minimise the chance of reoccurrence. This is achieved by progressing through a series of isometric, concentric and finishing with eccentric exercises, before resuming normal activities.
Like all hand and wrist conditions, the reason that de Quervain’s tenosynovitis can be so debilitating, is because it affects the tendons of the thumb. Because we use our thumbs all the time once the inflammation is present it can be difficult to rest enough to control it.
With this in mind, preventing the onset of inflammation is a much better option than trying to manage it. So here are 3 things we can do to help minimise the risk of the injury occurring in the first place:
1. Work on thumb ergonomics and positioning – ensuring you maintain a neutral wrist position and are not being forced into radial deviation.
2. If you notice that you get thumb tightness ore soreness engage in Finkelstein’s stretch to unload the tendons before they become inflamed. You can also look to use ergonomic pens and pencils to reduce the gripping load through the thumb.
3. Maintain good hand and wrist strength to minimise the risk of fatigue – this can be achieved through the regular use of a stress ball.
So that’s a brief overview of how de Quervain’s syndrome occurs and how to avoid it. If you have questions or comments feel free to e-mail us at firstname.lastname@example.org and we will happily answer them for you.
If you think you may still be suffering from de Quervain’s syndrome and want relief now, then call us on (08) 9486 8653 and we will arrange an appointment for you.