De Quervain’s Tenosynovitis

De Quervain’s tenosynovitis is a condition that affects the tendons on the thumb side of your wrist. It causes pain and swelling in the wrist near the base of the thumb. This condition is usually caused by repetitive hand or wrist movements, such as lifting heavy objects or activities that involve gripping, like gardening or playing certain musical instruments.

Pathophysiology of De Quervain’s tenosynovitis

The pathophysiology of De Quervain’s tenosynovitis involves inflammation and irritation of the tendons and their surrounding sheath at the base of the thumb. The condition typically arises from repetitive movements or overuse of the wrist and thumb, leading to microtrauma and subsequent inflammation.

Causes

This condition affects two tendons on the thumb side of the wrist. Tendons are cord-like structures that connect muscles to bones.

The most common cause is repetitive hand motions that strain the tendons, leading to thickening, swelling, and restricted movement. Other potential causes include:

• Inflammatory arthritis (e.g., rheumatoid arthritis)
• Direct wrist or tendon injuries, which may lead to scar tissue that limits movement
• Hormonal changes and fluid retention, such as those occurring during pregnancy

Symptoms

If you have de Quervain tenosynovitis, you may experience:

• Pain near the base of your thumb
• Swelling in the same area
• Difficulty moving your thumb and wrist, especially when grasping or pinching
• A “sticking” or “stop-and-go” sensation when moving your thumb

Without treatment, the pain can spread to your thumb, forearm, or both. Activities involving thumb and wrist movement may worsen the discomfort.

Risk factor

Several risk factors increase the likelihood of developing De Quervain tenosynovitis. These include:

1. Repetitive Movements: Engaging in activities that involve repetitive thumb and wrist movements, such as typing, using a computer mouse, or lifting heavy objects, increases the risk.
2. Forceful Gripping: Jobs or hobbies that require forceful gripping or pinching motions, such as using hand tools, sports equipment, or performing manual tasks, can contribute to the development of De Quervain tenosynovitis.
3. Gender: Women are more commonly affected by this condition than men, especially during pregnancy and the postpartum period, likely due to hormonal changes and increased strain on the wrist and thumb.
4. Age: While it can occur at any age, it is more common in individuals between the ages of 30 and 50.
5. Occupation: Certain occupations or professions that involve repetitive hand and wrist movements, such as assembly line work, carpentry, hairstyling, massage therapy, or typing-intensive jobs, pose a higher risk..
6. Inflammatory Conditions: People with inflammatory conditions, such as rheumatoid arthritis, have an increased risk of developing this condition.
7. Anatomical Factors: Anatomical variations or abnormalities in the tendons or the tendon sheath may predispose individuals to developing this condition.

Diagnosis of De Quervain’s tenosynovitis

 
The diagnosis of De Quervain’s tenosynovitis typically involves a combination of medical history, physical examination, and sometimes imaging studies. Here’s an overview of the diagnostic process:

1. Medical History: Your healthcare provider will start by asking about your symptoms, including when they started, what activities aggravate them, and any previous injuries or medical conditions. They may also inquire about your occupation and hobbies to assess potential risk factors for this condition.
2. Physical Examination: During the physical examination, your healthcare provider will assess the affected wrist and thumb. They may perform specific maneuvers to reproduce your symptoms, such as Finkelstein’s test. In this test, you’ll be asked to make a fist with your fingers closed over your thumb, and then bend your wrist towards your little finger. If this movement elicits pain over the thumb side of your wrist, it’s a strong indicator of De Quervain’s tenosynovitis.
3. Imaging Studies: While imaging studies are not always necessary for diagnosing De Quervain’s tenosynovitis, they may be ordered in cases where the diagnosis is uncertain or to rule out other conditions. X-rays can help identify any underlying bone abnormalities or arthritis, while ultrasound or MRI scans can provide detailed images of the tendons and surrounding structures, helping to confirm the diagnosis and assess the severity of inflammation

Physiotherapeutic management

Physiotherapeutic management of De Quervain’s tenosynovitis focuses on reducing pain and inflammation, improving range of motion, and strengthening the affected muscles and tendons. Here are some common physiotherapy approaches:

1. Rest and Activity Modification: Initially, resting the affected wrist and thumb is crucial to allow inflammation to settle. Your physiotherapist may advise avoiding activities that aggravate symptoms, such as repetitive gripping or twisting motions.
2. Splinting: A splint or brace may be recommended to immobilize the thumb and wrist, particularly at night or during activities that exacerbate symptoms. This can help reduce strain on the tendons and promote healing.
3. Ice Therapy: Applying ice packs to the affected area can help reduce inflammation and relieve pain. Your physiotherapist will guide you on the proper duration and frequency of ice application.
4. Manual Therapy: Hands-on techniques such as soft tissue massage, joint mobilizations, and stretching exercises may be used to improve flexibility, reduce muscle tension, and promote healing of the affected tendons.
5. Exercise Therapy: Specific exercises are prescribed to strengthen the muscles and tendons around the thumb and wrist. These exercises typically focus on improving grip strength, thumb movement, and overall wrist stability. Your physiotherapist will ensure that exercises are tailored to your level of pain and function.
6. Electrotherapy: Modalities such as ultrasound, electrical stimulation, or laser therapy may be used to reduce pain and inflammation in some cases.
7. Education and Ergonomic Advice: Your physiotherapist will provide guidance on ergonomic principles to prevent future aggravation of symptoms. This may include advice on proper posture, techniques for lifting and gripping, and modifications to your work or daily activities.
8. Activity Progression: As symptoms improve, your physiotherapist will gradually reintroduce activities and exercises to restore full function and prevent recurrence.
9. Home Exercise Program: It’s important to continue exercises and self-management strategies at home to maintain gains achieved during physiotherapy sessions.
10. Corticosteroid Injection Management: If corticosteroid injections are part of your treatment plan, your physiotherapist may provide advice on post-injection care and exercises to optimize the effects of the injection.