DeQuervain’s Tenosynovitis is a painful irritation of the tendons on the thumb side of the wrist. There are two main tendons affected, extensor pollicus brevis and abductor pollicus longus, which are responsible for movement and support of the thumb. They run along the back of the thumb and over the wrist and enable movement of the thumb away from the rest of the hand.
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Inflammation of the tendons and the sheath that covers them can occur due to overuse, injury or disease process. This causes swelling or thickening of the tendons. Once this occurs, it is difficult for the tendons to glide smoothly in the covering sheath, leading to pain and restricted movement. Several factors can increase a person’s risk of developing DeQuervain’s Tenosynovitis. These include:
- Repetitive activities requiring sideways or twisting movements of the wrist while gripping the thumb (eg. Hammering, racquet sports, fishing, chefs)
- Unaccustomed tasks involving the thumb such as a new mother repetitively lifting or carrying a baby
- Rheumatoid arthritis
- Injury to the thumb or wrist, such as with a heavy blow or knock
- Females are 6-10 times more likely to experience tenosynovitis
- Age (30-40 years or over)
Persons presenting with DeQuervain’s Tenosynovitis will have a very typical presentation including one or multiple of:
- Pain and/or swelling on the thumb side of the wrist
- Pain on stretching or flexing the thumb, particularly when the thumb and wrist are moved together
- Flicking or snapping sensation may occur with movement
- Tenderness to touch over the back of the thumb
- Difficulty gripping or holding objects
Our Physiotherapists are skilled at performing a range of orthopaedic tests to confirm the diagnosis of DeQuervain’s Tenosynovitis.
The initial aim of treatment is to reduce associated pain and inflammation. Treatment and management options include:
- Sufficient rest from aggravating activities, particularly those involving repetitive wrist or thumb movement
- Bracing or splinting of the wrist and thumb
- Reduce inflammation through rest, ice, compression, elevation and physiotherapy.
- Pain relief and anti-inflammatory medication as recommended by a doctor or pharmacist
- Physiotherapy- massage, ultrasound, ice therapy, joint mobilisation and stretches
- Range of movement exercises, stretching and strengthening
- Education and advice regarding activity modification or technique correction to avoid recurrent injury.
Occasionally, a referral for additional treatment such as a corticosteroid and anaesthetic injection into the tendon sheath may be considered. Your Physiotherapist will discuss this with you if your symptoms are not resolving as expected.