Thumb
Introduction
De Quervain’s tenosynovitis/disease (DQV), is an overuse condition that results in pain on the radial or thumb side of the wrist.
Definition
DQV is the inflammation of the extensor pollicus brevis (EPB) and abductor pollius longus (APL) tendon sheaths, as they run underneath the 1st dorsal extensor compartment. These tendons attach the muscles to bone and are responsible for the upwards and outwards movement of the thumb, needed when grasping an object.
The inflammation of the tendon sheaths results in increased fluid and reduced glide of the tendons, leading to friction and pain with repetitive or prolonged thumb and wrist movements.
Causes
DQV is a common condition that is generally linked to overuse and work related, repetitive movements. There are many activities in our daily lives that may result in the development of DQV.
Increased use of mobile phones, ipad’s, gaming consoles.
- Laptop use/desk set up with the wrist in increased extension/deviation.
- Pregnancy – increased fluid can result in more pressure at the wrist.
- New parents/grandparents – repetitive lifting with thumbs extended, patting, prolonged holding during feeds with wrist in end range flexion.
- Commencement of high intensity and jarring workouts – kettlebells, burpees, push up challenges, etc.
- Manual workers or DIY enthusiasts – increased repetitive tasks, eg: painting, moving bricks, etc. This can include a one off day of intense work.
- Underlying chronic inflammatory conditions, eg: osteo or rheumatoid arthritis.
- Direct trauma to the area.
- Scar tissue from wrist fractures, leading to reduced glide of the EPB/APL tendons.
Signs & Symptoms
Formal Measures:
- Ultrasound – this can be used to confirm direct inflammation of the EPB/APL tendons at the 1st dorsal compartment.
- Finkelstein’s test – this is completed with your hand therapist or treating physician. It involves placing your thumb into your palm and moving your wrist towards the floor.
Symptoms:
- Tenderness, swelling and pain at the wrist and near the base of the thumb. Pain can also sometimes radiate up the forearm.
- Pain can be sharp or burning, down to a dull ache and can be constant or with specific activities.
- Pain with picking up larger objects with thumb out stretched and wrist in end range flexion or extension.
- Pain overnight/on waking.
- Decreased thumb/wrist movement and decreased grip strength.
Treatment
DQV can present as mild or of a chronic nature, that builds over time or it can come on seemingly suddenly and with a high, debilitating level of pain. Treatment should be individualised for each person but in general is aimed at reducing inflammation and pain, increasing range of movement and strength and return to desired functional tasks.
Conservative:
- Splinting – this usually includes immobilisation of the base of the thumb and the wrist and can vary from wearing it full time, to overnight and during aggravating activities. Splinting can be of the custom made or prefabricated variety, determined by the frequency and intensity of your pain.
- Activity modification – this usually includes an initial period of avoiding known aggravating activities until pain settles. It often also requires making some small, long term changes to daily habits.
- Soft tissue massage – the muscle bellies of the EPB/APL tendons are further up the forearm. Releasing any tightness in these can reduce tension at the level of inflammation.
- Strengthening both of the affected tendons, as well as surrounding wrist tendons.
- Kinesio taping – this can be help to reduce pain and movement of the thumb when splinting during the day is not practical or tolerated.
Medications:
- Your GP may recommend a course of oral or topical anti-inflammatory medication.
- Persistant DQV, that does not respond well to conservative management, may benefit from an ultrasound guided cortisone injection.
Surgical:
- Surgical release of the 1st dorsal compartment can be performed for persistent and functionally debilitating presentations of DQV. This requires avoiding heavy lifting/gripping for 6 weeks post surgery.
How Can I Prevent DeQuervain’s Tenosynovitis?
Activity modification is key. If you notice early pain on the thumb side of your wrist, pay attention. Consider the following:
- Pacing activities.
- Avoiding repetitive or prolonged, end range wrist and thumb movements.
- Using two hands for heavy lifting.
- Consider a basic wrist brace for overnight
Melbourne Hand Therapy Can Help You
DQV can be a persistent and niggling condition that impacts simple daily activities. The best approach to managing DQV is to have a program that is individualised for you. At Melbourne Hand Therapy, we can provide a thorough assessment, advise on appropriate splinting options and help formulate a treatment plan that reduces your pain and helps you return to the activities that are most important to you. We are also able to advise on when a medical or surgical consultation is appropriate.
