De Quervain's Tenosynovitis

What is it?

De Quervains is an overuse injury of the tendons that control movement of the thumb causing inflammation in the synovium of the abductor pollicis longus and extensor pollicis brevis tendons. Irritation occurs where the tendons pass through their synovial sheath in a fibro-osseous tunnel at the level of the radial styloid ie. along the outer aspect of the wrist-thumb junction. (Brukner and Khan, 2012)

 

Signs and Symptoms:

  • Pain in the region described above and sometimes further up into the forearm where the muscles originate
  • Swelling 
  • Crepitus - a grating/crackling sound when moving the thumb/wrist 
  • Pain +/- weakness with resisted thumb extension and abduction
  • Positive Finklesteins test – involves making a fist with the thumb inside and tilting the wrist towards the ulnar direction ie away from the thumb

Causes:

This condition generally results from an increase in use/loading of the muscles and tendons that control the thumb. It is more common in women, particularly new mums. Some say that this is related to repetitive lifting/carrying of a new baby. Athletes who play racquet sports, golfers and cyclists are at a higher risk of developing this condition. Also, computer based and mobile phone activity is a common aggravating factor.

Management:

  • Load modification is the key! It is advised to avoid sustainedor repetitive loading of the thumb to allow time for symptoms to settle and for recovery to occur.
  • Physiotherapy – can assist with load modification by providing splints (thumb spica) for support and movement restriction. The application of tape and the use of manual therapy, electrotherapy and sometimes cryotherapy to alleviate symptoms can be very helpful. (Maloney Backstrom 2002)Ideally a physiotherapist who specialises in hand therapy would be recommended.
  • Rehabilitation can help to improve the condition of the tendons in question and the surrounding structures which may be affected by pain inhibition is essential for return to baseline functional use.
  • NSAID’s – anti-inflammatory medications may be prescribed to settle inflammation and hence relieve pain so that rehabilitation can be commenced/progressed. Husstede et al, 2014).
  • Injection therapy – research has shown a positive response to corticosteroid injections with this condition particularly if it is not settling with conservative management in the initial 6 weeks. (Peters-Veluthamaningal et al, 2009) This is generally followed by splinting to immobilise the area.
  • Surgery – in very rare cases surgical release of the tendons may be carried out if other aspects of management have been unsuccessful.