De Quervains is an inflammatory condition of the sheaths surrounding two muscle tendons in the wrist. The function of these muscles is to move the thumb with good wrist control. These tendons are connected to the adductor pollicis longus (APL) and extensor pollicis brevis (EPB). The structures that get inflamed, painful and tender are the sheaths around these tendons where they pass through n fibrous tunnel. This condition can also be explained as the narrowing of the tunnel thus causing pressure on the structures described above.

What causes De Quervain’s tenosynovitis?

This painful condition can be brought on by sports activities such as:

  • Racquet sports
  • Ten-pin bowling
  • Rowing
  • Canoeing
  • Weight lifting
  • Golf

It is not limited to just these sports activities, can be seen in similar repetitive movements in other activities and is also seen during pregnancy due to a change in tissue flexibility.

What are the symptoms of De Quervains?

De Quervains has a slow onset with no obvious signs and symptoms initially. It is due to repetitive micro-trauma, overuse, overload or overstrain. Patients can however complain of the following:

  1. Decreased ability to grip with the affected hand.
  2. Pain and tenderness on the thumb side of the wrist.
  3. Swelling at the site of pain.
  4. Pain upon bumping the site of the pain.

How can Physiotherapy help to treat De Quervains?

Physiotherapy can help with accurately diagnosing the condition and excluding possible other conditions (Radial nerve issues or arthritis of the thumb). Physiotherapists are trained to assess and treat musculoskeletal conditions such as these.

When it comes to treating this condition, conservative methods have been proven to give the best results. The first line of action is to relieve your pain. This can be done with the following physiotherapy treatments:

  • Splinting for 3-4 weeks (with a bought brace or one made by an occupational therapist.
  • Research has shown that splinting alone does not give us the desired healing and getting 1-2 cortisone injections have proven to speed up the process. We do however recommend that you refrain from going for more than 2 cortisone injections as it does put your tendon at danger for rupture.
  • During the splinting and cortisone regime other physiotherapy techniques such as myofascial release, neural and specific joint mobilisation is done in the rooms and adjusted as a home exercise programme. This includes individually indicated stretches and graded strengthening.

If the conservative treatment did not work, a surgical release is required where the surgeon will loosen the tunnel in order to give the affected structures relief from the restraint. In this case rehabilitation will be according to your surgeon’s protocols. If,  in time, you detect that your scar is painful and the hand is stiff, physiotherapy can help with various treatments such as myofascial release, neural and specific joint mobilisation and dry needling, should this be indicated in your assessment.

This article was authored by Danielle Ross, who is based at the Douglasdale branch of Lamberti Physiotherapy. Book an assessment with her if you think you may have this condition or else Carpal Tunnel Syndrome. You can also make use of our handy appointment form.

References:

  1. Brukner P, Khan K 2012 Brukner & Khan’s Clinical Sports Medicine, 4th ed. McGraw-Hill Australia Pty Ltd, Australia.
  2. Mennen U, van Velze C 2008 The Hand Book: A practical approach to common hand problems, 3rd ed. Van Schaik Publishers, Pretoria.
  3. Muscoline J 2009 The Muscle and Bone Palpation Manual with Trigger Points, Referral Patterns, and Stretches, 1st ed. Mosby, Inc. an affiliate of Elsevire Inc., Missouri.
  4. Lund J 2018 Wrist and Hand. PowerPoint presentation at SPT 2018.