Injury blog: De Quervain’s tenosynovitis
This month we switch focus to the wrist and hand, and to a condition known as De Quervain’s tenosynovitis (pronounced ‘tee-no-si-no-vi-tis’). This condition affects some of the tendons of muscles that help control thumb movement. It can cause considerable pain and disability in the process.
Anatomy...
If you lie your hand flat on a table and spread your fingers (and thumb) as wide as you can, you will notice a small hollowed-out section on the thumb side of the wrist. This region is known as the ‘anatomical snuffbox’. The walls of the snuffbox are made up of two tendons that pass from the forearm to the thumb. These tendons belong to two muscles: the abductor pollicis longus (APL) and the extensor pollicis brevis (EPB). The words abductor and extensor refer to the movements they help the thumb to perform… abduction (taking the thumb away from the palm) and extension (taking the thumb out to the side of the hand). Pollicis refers to thumb, and longus and brevis refer to long and short respectively.
Tendons are cord-like structures that attach muscle to bone. At the point where these tendons pass over the wrist joint, they pass through a thin, tunnel-like structure called a sheath in a smooth and frictionless manner. ‘Tenosynovitis’ refers to inflammation of the tendons and sheaths.
Cause...
The cause of De Quervain’s is not completely understood, but it is strongly associated with overuse of the previously mentioned structures. Overuse leads to degeneration of the tissues, and one of the ways the body adapts to these changes is thickening of those affected tissues. This leads to the tendon being trapped within the sheath, which ultimately leads to poor movement and pain. Any activity that leads to chronic overuse of the thumb can lead to the development of this problem. Common activities include playing the piano, fishing and typing. New mothers are regularly affected due to the repetitive action of picking up their baby with thumbs held out from the hand. With the explosion of smart phones and other technologies over the past decade comes a new population of sufferers also… texters! Those people who spend long periods of the day sending text messages and typing on mobile phones are more likely to experience this disorder.
Signs and symptoms...
The main symptom of De Quervain’s is painful thumb and wrist movement. Any movement where the thumb moves away from the hand may be painful. The pain is mainly felt around the snuffbox area of the wrist. Other signs and symptoms include:
Restricted thumb and wrist movement
Difficulty and pain with gripping objects
Pain that radiates up the forearm
Swelling over the snuffbox region
Popping and clicking of the tendons as they move through their sheaths
Weakness of the thumb
Tingling and/or pins and needles in the hand
Treatment...
In order to get the right treatment for this condition, you must first be diagnosed correctly. Your first port of call should therefore be a consultation with us! We are armed to the teeth with ways to treat this sometimes-menacing condition. We may use any or all of the following techniques to help you in the process:
Soft tissue release of the tight and/or shortened muscles that help to control thumb and wrist movements. We may massage you all the way from the neck down to the hand during treatment.
Mobilisation of the joints. Again, we might focus on joints in the neck, all the way down to the smaller thumb and wrist joints.
Stretching of tight muscles during treatment and also as part of a home exercis program.
Taping of the forearm, wrist and thumb to decrease pain and improve function of the hand.
Some of the things you can do at home to improve this condition include:
Ice or heat pack therapy to increase flow of blood through the region to aid with recovery and decrease pain.
Exercise to help strengthen and stretch weak and tight muscles.
If in doubt, check all homework by us first – it’s always better to get tailor-made care when injured.
Other forms of treatment include splinting, steroid injection and surgery. These forms are either more disabling to begin with, or more invasive. We always try to take a gentler approach to start and leave these treatments for those instances that do not respond to gentler techniques.
To close…
Do you need help with thumb or wrist pain? Does your job or hobby mean you perform repetitive tasks with your thumbs each day? If this is the case, call us today on (02) 8960 8759 to begin your journey to pain-free movement… and happiness! Now that’s something we’ll give a thumbs up to!