What is De Quervain's tenosynovitis?

De Quervain's Tenosynovitis is a painful inflammatory condition affecting the tendons located at the wrist's base near the thumb. The primary symptom is pain, which intensifies with thumb abduction, hand gripping movements, and wrist ulnar deviation. Swelling and thickening of the affected area may also occur.

What are the causes?

De Quervain's tenosynovitis usually occurs from overusing your thumb or wrist, especially in repetitive activities during work or sport that involve lifting (extension) of your thumb. In many cases the cause is unknown. It is more common in women, particularly after pregnancy. It can also be caused by a simple strain.

What are the symptoms?

The main symptoms are pain and swelling near the base of the thumb. Movements involving the thumb and wrist such as making a fist, pinching, grasping or wringing make the pain worse. In some cases, there is a creaking sound or feeling as the tendon slides through its sheath.

How is it diagnosed?

Finkelstein’s test is a simple way of diagnosing De Quervain’s Syndrome. It can be performed by placing your thumb in the palm of your hand and making a fist around it, then bending your wrist towards your little finger. The test is considered positive if the pain at the base of your thumb gets worse. In some cases, an ultrasound scan and an X-ray may be taken to eliminate other issues.

What is the treatment?

• Rest
  • Limit the aggravating movements can aid healing of the tendon.
• Ice
  • Place an ice pack onto your thumb and wrist for 15 to 20 minutes every 3 or 4 hours. Do not put ice directly next to skin as it may cause ice burn.
• Splinting
  • Wear a splint that can prevent your thumb from bending.
• Anti-inflammatory medicine or gel (e.g. ibuprofen)
  • It reduces pain and inflammation
• Physiotherapy
  • Your physiotherapist will explain what might aggravate your symptoms.
  • Common physiotherapy includes:
    • Sport taping
    • Pain relief modalities:
      • Ultrasound
      • Interferential Therapy
      • Transcutaneous electrical nerve stimulation
      • Magnetotherapy
    • Shock Wave Therapy
    • Manual Therapy
    • Acupuncture
    • Rehabilitation exercise
• Steroid Injection
  • If your symptoms persist after physiotherapy, your doctor may recommend steroid injection into the base of your thumb. This helps to reduce swelling and pain.
• Surgery
  • If pain persists despite trying the above treatments, surgery may be needed.

Rehabilitation Exercise

	Finkelstein’s Stretch: Bring your arms out in front of you. Bend your thumb toward your palm. Use your other hand to gently stretch your thumb and wrist downward until you feel the stretch on the thumb side of your wrist. Hold for at least 15 to 30 seconds. Repeat 2 to 4 times.
	Wrist flexion exercise: Hold a dumb bell in your hand with your palm facing up. Bend your wrist upward. Slowly lower the weight and return to the starting position. Do 3 sets of 10. Gradually increase the weight of the can or weight you are holding.
	Opposition stretch: Rest your hand on a table with your palm facing up. Touch the tip of your little finger with your thumb. Hold this position for 6 seconds. Repeat 10 times.
	Wrist stretch: With help of the opposite hand, press the back of your hand and hold for 15 to 30 seconds. Next, stretch the hand back by pressing the fingers in a backward direction and hold it for 15 to 30 seconds. Keep your elbow straight during this exercise. Do 3 sets on each hand.
	Wrist extension exercise: Hold a dumb bell in your hand with your palm facing down. Slowly bend your wrist upward. Slowly lower the weight down into the starting position. Do 3 sets of 10. Gradually increase the weight of the object you are holding.
	Hand grip exercise: Squeeze a rubber ball and hold for 5 seconds. Do 3 sets of 10.

(All information provided is for reference only. Please contact your physiotherapist or physician should you have any enquiry.)

References:

Coleman, S., & Clapis, P. (2009). De Quervain’s Tenosynovitis Rehabilitation Exercises. NewYork-Presbyterian Hospital Weill Cornell Medical Center. https://www.rickysinghmd.com/wp-content/themes/ypo-theme/pdf/dequervainstenosynovitis.pdf

De. (n.d.). Thumb Pain (De Quervains Tenosynovitis). KAISER PERMANENTE. Retrieved October 26, 2024, from https://mydoctor.kaiserpermanente.org/ncal/Images/Dequervains tenosynovitis_012701-010 (12-14) ADA_tcm75-1235338.pdf

De Quervain’s tenosynovitis. (2021, July). NHS. https://www.leicspart.nhs.uk/wp-content/uploads/2021/08/595-De-Quervains.pdf

Physiopedia. (2011). De Quervain’s Tenosynovitis. Physiopedia. https://www.physio-pedia.com/De_Quervain's_Tenosynovitis