De Quervain’s syndrome

Written by Giovanni Bruno

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What is De Quervain’s syndrome?

De Quervain’s tenosynovitis or syndrome is a painful condition affecting the tendons around the thumb side of your wrist. Typically the tendons that get inflamed are the abductor pollicis longus and extensor pollicis brevis. Normally your tendons glide smoothly through the small tunnel that connects them to the base of the thumb, but when you’re suffering with De Quervain’s syndrome that is not possible anymore due to swelling and thickening inside your joints. Movements such as turning your wrist or grasping objects, making a fist or anything that will increase pressure on your wrist, will most likely cause pain.

What are the symptoms of De Quervain’s syndrome?

Patients affected by De Quervain’s Syndrome often complain about:

  • Thumb pain (typically at the base of the thumb).
  • Swelling at the base of the thumb.
  • Struggle to do any movement that involves grasping or pinching. As well as any movements that apply pressure on the thumb.
  • A feeling of blockage inside the thumb and the need to stop any movements and then start moving your thumb again.
  • Pain may change from patient to patient, but typically is described as a constant aching, burning, pulling sensation.
  • Other symptoms may include loss of strength or pins and needles in the wrist.

If the symptoms do not improve without treatment, the pain may spread further into your thumb, and into your forearm.

What are the common causes of De Quervain’s syndrome?

The most common cause of De Quervain’s Syndrome is chronic repetitions of stressful movements of your wrist. However, the exact cause of De Quervain’s tenosynovitis is not well understood. One of the theories of the pathophysiology of tenosynovitis has been attributed to myxoid degeneration. As a consequence of this process fibrous tissue starts depositing inside the tendons (abductor pollicis longus and extensor pollicis brevis). This deposition results in a thickening of the tendon sheath causing a lack of motion. If left untreated the inflammation and progressive narrowing of the tendons canal due to the deposition of fibrous tissue, can lead to inability to move your wrist and your thumb.

There are different factors that may increase the risk of De Quervain’s tenosynovitis. You can find a small number of those below:

  • Age: individuals aged 30 to 50 are more likely to develop symptoms.
  • Gender: Women are more affected compared to men.
  • Pregnancy: De Quervain’s syndrome has been associated with pregnancy due to mechanical and hormonal changes within the body during pregnancy.
  • Activities: Work and daily activities that involve repetitive hand and wrist movements may contribute to de Quervain’s tenosynovitis.

Activities that focus on repetitive hand or wrist action can make the symptoms worse. These activities include:

  • A direct blow to the thumb
  • Tennis
  • Cutting vegetables
  • Golf
  • Gaming
  • Gardening
  • Inflammatory conditions such as rheumatoid arthritis
  • Overuse
  • Repetitive workplace tasks

How is De Quervain’s syndrome diagnosed?

Before the physical examination your healthcare professional will go through your medical history and look for any risk factors that may contribute to your symptoms.

Your GP or your healthcare professional will check your hand to see if it hurts when he puts pressure on the thumb side of your wrist. Next, you will be asked to do some physical tests such as the Finkelstein’s test. Specifically for this test the doctor will ask you to bend your thumb across your palm and bend your fingers down over your thumb to make a fist. This movement stretches your tendons. If it hurts on the thumb side of your wrist, you may have de Quervain’s tenosynovitis.

What are the treatment options for De Quervain’s syndrome?

Avoid certain activities. To help reduce pain and swelling it is advised to avoid the activities that exacerbate your pain.

Use a splint. Your healthcare professional may suggest using a thumb splint. This will hold your thumb and wrist firm and still. Instructions on how long and when to use your splint may vary from practitioner to practitioner. But it is common to use it for a 4 to 6 week period.

Medication. over-the-counter pain relievers like ibuprofen or naproxen are used to reduce the pain and swelling. Talk to your doctor for more advice and information on suitable medication.

If medication doesn’t work, your doctor may suggest trying a steroid injection into the thumb. This type of injection is used to help reduce the swelling and pain felt around the thumb.

Hot and cold therapy. Using a hot compress or a cold compress on the area can help with the reduction of inflammation. This can then help improve the movement of the thumb.

Manual Therapy – manual therapy may be advised to help release and relax the tight musculature that is causing your pain. During your treatment your therapist may also look at any mechanical imbalances in your body that may be affecting the way that you’re using your affected arm and wrist. Exercises will be prescribed to help stretch and strengthen your hand and wrist. This will help to improve your hand function.

Surgery. If the previous treatments do not work your doctor may refer you to a specialist hand consultant. The goal of surgery is to relieve pressure of the tendon’s sheath which helps improve the sliding and movement of the tendon. It’s an outpatient operation, which means you can go home just afterward. It may then be recommended afterwards to see the physical therapist again for post-surgery exercises to strengthen your thumb and wrist.

Recovery from surgery is not instant and may take a while. Your pain and swelling should disappear quickly, but the area may be tender for several months. After a couple of weeks you should get your stitches removed. Then you’ll start physical therapy again for 6 up to 8 weeks.

What are the best exercises for De Quervain’s syndrome?

Increasing Strength of your fingers and thumb is a crucial part of your wrist rehabilitation. Your wrist needs to be reinforced in different types of movements. Several exercises have shown effectiveness in decreasing the pain and improving range of motion. Below you will find a list of common exercises that may help you manage your wrist pain. Start practising exercises slowly and gradually and if you start to have pain stop doing them.

  • Thumb Lifting – start with your elbow at 90 degrees and your hand facing forward. Move your thumb away from your palm creating a ‘C’ shape. Hold for 10 seconds. Repeat 10-15 times depending on your pain and symptoms.
  • Passive thumb flexion mobilisation – start with your elbow at 90 degrees and turn your hand so your thumb faces up and little finger faces down to the ground. Use the thumb of your other hand to bend your painful thumb down. Hold for 15-20 seconds and repeat up to 5 times.
  • Thumb side stretching – begin by holding your arm out in front of you. Bend your thumb in towards your palm.Use your other hand to gently push down on the wrist and thumb until you feel a stretch on the thumb side of your wrist. Hold for 20 seconds and repeat 5 times.
  • Elastic band ulnar deviation – sit on a chair with your feet flat on the ground. Bend forward making sure your feet are hip width apart. With your painful hand take hold of the resistance band, resting your elbow on your thigh. Stand on the other end of the resistance band with your opposite foot. With your palm facing down slowly start to bend your wrist sideways away from your knee. Repeat 15 times.

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What is the difference between an Osteopath and Chiropractor?

The primary objective for both Osteopaths and Chiropractors is, most frequently, to relieve aches and pain. However, osteopaths also treat a broader range of functional problems, such as disorders of the respiratory or digestive systems. Both Osteopaths and Chiropractors treat Free Osteopathy Discovery Sessionmore than just bones joints and soft tissues. By working with the nervous system and blood supply they are able to influence all of the bodies systems, making them capable of alleviating the symptoms of a number of diagnosed medical conditions, such as; asthma, stress, digestive disorders, period pain, migraine and many more.

In many cases, patient experiences with osteopaths and Chiropractors will be very similar; however, there are some differences. When diagnosing patients, osteopaths and Chiropractors both use visual inspection (observation) and palpation (touch). Chiropractors frequently rely on more diagnostic procedures, such as X-rays, MRI scans, blood tests, and urine tests. Osteopaths tend to place more emphasis on the physical examination and will generally refer patients on for more diagnostic procedures if required.

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