De Quervain's Tenosynovitis
De Quervain's tenosynovitis is a condition of inflammation of tendons in the thumb that leads to tenosynovitis. The repeated rubbing of the swollen tendons and their coverings adjacent to their narrow tunnels results in de Quervain's Tenosynovitis. This leads to severe pain at the base of the thumb and this pain further gets extended to the lower arm.
The tendons involved in the thumb are abductor pollicis longus and extensor pollicis brevis tendons.
This is found more frequently in racket sports like badminton, squash, ten pin bowling, tennis and canoeing. Golfers thumb could also be taken as an example for de Quervain's tenosynovitis.
Causes and Risk Factors of De Quervain's Tenosynovitis:
The cause of de Quervain's tenosynovitis is still not known. However, same repeated movements, certain inflammatory conditions, repetitive grasping, a direct blow to the thumb could be helpful in identifying this disorder.
Few other causes may include:
- Muscle weakness.
- Muscle tightness.
- Joint stiffness.
- Excessive training or activity.
- Poor sporting technique or equipment.
- Poor posture.
- Poor ergonomics.
- Insufficient warm up.
- Injury to the nerves, neck or upper back.
Racquet sports and gardening are also the possible causes for exacerbation of de Quervain's tenosynovitis.
Signs and Symptoms of De Quervain's Tenosynovitis
The symptoms of de Quervain's tenosynovitis may include:
- Pain, which may occur suddenly or gradually along the back of the thumb directly over two thumb tendons, is common in de Quervain's.
- Feeling of increased pain in the affected area when pressure is applied.
- The pain travels from the thumb along the forearm.
- Pain and swelling at the base of the thumb could also be experienced.
- Pain could become severe with thumb and wrist movements.
- Thumb movements may be painful and difficult.
Treatment for De Quervain's Tenosynovitis
Treatment for de Quervain's tenosynovitis may include:
- Anti inflammatory drugs may be recommended.
- Cortisone injection is really helpful.
- TENS Unit.
- Splinting, bracing, and rest.
- Extra thick pens can be used for reducing the pressure on the tendons.
- Cold therapy and ultrasound therapy for reducing pain.
- Surgery as a last resort is performed only when cortisone injection fails to work properly.
- Activity modification and training.
- Appropriate plan for return to activity.
Physiotherapy for de Quervain's tendonitis is important in speeding up the healing process and to get optimal results. Physiotherapy also decreases the likelihood of recurrences in the future. Physiotherapy may include:
- Soft tissue massage.
- Joint mobilization.
- Heat and ice treatments.
Exercises for De Quervain's Tenosynovitis:
Strengthening and stretching exercises help in treating this problem.
EPL Stretch Exercise: Curl the fingers up around the thumb keeping the elbow straight. Bend the wrist towards the side of the little finger gently until a mild to moderate pain-free stretch is felt. Hold for 5 seconds and release. Repeat 5 to 10 times ensuring there is no exacerbation of symptoms.
Tennis Ball Squeeze: This exercise involves holding a tennis ball in the hand and squeezing it as hard as possible ensuring comfort without pain. Hold for 5 seconds and release. Repeat 5 to 10 times ensuring there is no exacerbation of symptoms.
A specific type of test known as Finkelstein test is done on physical examination to diagnose de Quervain's tenosynovitis. This test is done by making a fist by placing the thumb beneath the palm. The tendons that are swollen are stretched and pulled through the tight space when the wrist is bent towards the outer side. If this test causes pain then it is positive for de Quervain's tenosynovitis.
Other diagnostic tests may include:
- CT scan.