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De Quervain’s Tendonitis

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Sometimes known as De Quervain’s Tenosynovitis, this particular condition happens when the tendons surrounding the base of the thumb are irritated and constricted. Tendonitis refers to tendons that are swollen and inflamed. When the tendons become thick, they can cause tenderness and pain along the thumb part of the wrist. This tends to be more noticeable when making a fist, gripping things, grasping onto something or trying to turn your wrist.

Most of the time, the bone is broken as a result of falling onto an arm that is outstretched or being hit on the wrist. For those who participate in contact sports, inline skaters, bikers and skiers, this is the most common injury. If you have thinning of the bones and osteoporosis, you are at an increased risk for these fractures. Anyone can get this type of fracture if they were to get hit or fall.

Wrist fracture can also be caused from a high impact road traffic accident, as the hands are on the steering wheel trying to brace during impact. This can forcibly hyper extend the hand and wrist, causing the fracture. 

But how do you know if you have a Colles’ fracture? First of all, the fracture should be ruled if you have taken trauma to the wrist, such as a fall on the outstretched arm. You will also notice sharp pain when moving the wrist, and there may be inflammation and swelling present. The most painful movements of the wrist are flexion and extension (i.e. bending or extending your wrist).

De Quervain’s Tendinitis Anatomy

Two of the main tendons that run to your thumb pass along a tunnel that is located on the thumb side in your wrist. Tendons are a rope-like structure that attaches the muscles to the bones. Tendons are covered with a slipper layer of soft-tissue (synovium). This layer lets the tendons slide with ease through the tunnel. Anytime the tendons that are near the nerves become inflamed, it can put a lot of pressure on the nerves. In the end, you suffer with numbness in the fingers and pain in the wrist. 

The symptom that most people report is pain at the base of the thumb. People who suffer tend to be people who use the thumbs and fingers a lot, such as writers, computer users, or people who have hobbies doing crafts.

De Quervain’s Tendonitis anatomy image

How To Treat De Quervain’s Tendinitis

1. Splints

Splints are often used to allow the wrist and thumb to rest and recover.

2. Manual Therapy

Massage, mobilisation to the wrist, and stretching to the forearm muscles will all aid the recovery. Exercises will also be prescribed by your therapist. Ice or heat therapy might be something you can do at home to assist the recovery. The therapist might also use acupuncture, electrotherapy or LASER to help speed up healing. 

3. Anti-Inflammatory Medication

These particular medications are either injected or taken orally into the compartment of the tendon. They can help to alleviate swelling and pain at the sight of the injury. However many people get best response from simply using ice and/or heat. Your therapist will be able to advise you more on this.

4. Avoiding Activities That Contribute To Swelling And Pain

Engaging in activities that further cause pain and swelling will only make the condition that much worse. If you are able to refrain from those activities, you will find that the symptoms will go away on their own. Minimise aggravating factors and adapt your technique to take pressure off your wrist/thumb.

5. Corticosteroids

Injecting corticosteroids into the sheath of the tendon will help to alleviate pain and swelling. Often a local anaesthetic is used in combination with the steroid to reduce the soreness from the steroid injection.

5. Surgery

If the symptoms are severe or they don’t improve, surgery might be the only option. The main goal of surgery is to open the compartment to create room for all of the irritated tendons. Normal use of your hand and wrist can be resumed after strength and comfort have returned. An orthopaedic surgeon can discuss the best form of treatment for your specific situation.

Tips

  • Pain with this condition is often felt over the thumb side within the wrist. This is considered to be the main symptom of the condition. Pain can appear suddenly or over the course of time. Pain is often felt in the wrist and makes its way up to the forearm. It will often worsen when the thumb and hand are being used. Forcefully grasping at objects and twisting the wrist make the pain worse.
  • Swelling can occasionally be seen along the thumb side of your wrist. Swelling is often accompanied by a fluid-filled cyst, known as a ganglion.
  • Snapping or catching sensations are often felt when the thumb moves.
  • Swelling and pain make it quite painful to move the wrist and the thumb.
  • Numbness is often felt at the back of the index finger and the thumb. It is often caused by the nerve that lies along the top of the tendon’s sheath becoming irritated.
  • The most important tip is this: try to minimise the thing you are doing that is aggravating your pain. There may be some cases where this is very hard, for example, picking up your baby repeatedly. So, discuss with your therapist ways you can minimise the pain by adapting your technique.