PT Tip of the Month Archive

De Quervain’s Tenosynovitis

Introduction

De Quervain’s tenosynovitis (or tendonitis) is an inflammation of the tendons located on the radial side (thumb side) of the wrist. Like other tendonitis conditions, these tendons can become irritated and sore from repetitive movements or overuse. Typical movements that aggravate these tendons include activities that involve thumb pinching, gripping or squeezing objects, and moving the wrist in the opposite direction of the thumb.

Anatomy

There are two muscles and corresponding tendons which are implicated in de Quervain’s tenosynovitis. The tendons are enclosed in a tendon sheath, which is what becomes inflamed. The two muscles are the Extensor Pollicis Brevis (EPB) and Abductor Pollicus Longus (APL) muscles. The actions of these muscles are to move the thumb up and away from the hand and are active with fine and gross motor tasks that involve pinching, gripping, and squeezing.

Causes

De Quervain’s is commonly seen in new moms, as they are repetitively gripping toys and bottles or picking up and carrying their infant. People who perform a lot of gardening, knitting, cooking, or washing laundry by hand (due to wringing motion) are also susceptible to getting de Quervain’s. People with metabolic disorders such as diabetes or rheumatoid arthritis, or are pregnant or undergoing menopause, may also be susceptible to DeQuervain’s, as these people often suffer from fluid retention, which may constrict the tendons. Although de Quervain’s can affect anyone, it is most often seen in females, ages 30-50 years old.

Signs and symptoms

The most common complaint from people suffering from de Quervain’s tenosynovitis is pain at the thumb side of the wrist. Pain can also radiate to the forearm. The pain is exacerbated when moving the thumb and wrist, and with pinching, grasping, and squeezing objects. Some people may also experience swelling at the base of the thumb or notice a fluid-filled cyst in that region.

Treatment

Your skilled physical therapist will be able to perform appropriate tests and measures to determine if you are suffering from de Quervain’s tenosynovitis. Physical therapy treatments may consist of pain and edema management, education on possibly using a splint or brace, appropriate stretches and strengthening exercises, soft tissue mobilization, joint mobilizations, and/or modalities. If you think you are experiencing signs and symptoms of de Quervain’s tenosynovitis and would like to be scheduled for a physical therapy evaluation, please contact 617-232-PAIN (7246) for our Brookline office and 617-325-PAIN (7246) for our West Roxbury office.

References

  1. Anderson M and Tichenor CJ. A patient with de Quervain's tenosynovitis: a case report using an Australian approach to manual therapy. Phys Ther. 1994;74:314-326.

  2. Backstrom KM. Mobilization with movement as an adjunct intervention in a patient with complicated de Quervain's tenosynovitis: a case report. J Orthop Sports Phys Ther. 2002;32:84-5.

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