De Quervain Tenosynovitis

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De Quervain's tenosynovitis is inflammation of tendons on the side of the wrist at the base of the thumb. These tendons include the extensor pollicis brevis and the abductor pollicis longus tendons.

Also known as:
  • Radial styloid tenosynovitis
  • de Quervain disease
  • de Quervain's stenosing tenosynovitis
  • mother's wrist and mommy thumb
  • washerwoman's sprain
History of De Quervain Tenosynovitis:
In 1895, a Swiss surgeon, Fritz de Quervain, published 5 case reports of patients with a tender, thickened first dorsal compartment at the wrist. The condition has subsequently borne his name, De Quervain tenosynovitis.

Anatomy:
Two of the main tendons to the thumb pass through a tunnel (or series of pulleys) located on the thumb side of the wrist. Tendons are rope-like structures that attach muscle to bone. Tendons are covered by a slippery thin soft-tissue layer, called synovium. This layer allows the tendons to slide easily through the tunnel. Any swelling of the tendons located near these nerves can put pressure on the nerves. This can cause wrist pain or numbness in the fingers.


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De Quervain tenosynovitis of the first extensor compartment.
Investigation:
The Finkelstein Test: The Finkelstein test is conducted by making a fist with the fingers closed over the thumb and the wrist is bent toward the little finger.

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Finkelstein test: Arrow indicates location of pain when test is positive.
The Finkelstein test can be quite painful for the person with De Quervain's tendinitis.
Tenderness directly over the tendons on the thumb side of the wrist is a common finding with this test.


      Treatment Of De Quervain Tenosynovitis
  • Rest, splinting if necessary.
  • Using an extra thick pen may help as this reduces the stretch on the tendons when writing.
  • Ice or cold therapy to reduce pain and inflammation.
  • Ultrasound
  • Stretching and strengthening.
  • A cortisone injection may be given.
  • In rare cases surgery may be indicated.
What can a physical therapist do to help in De Quervain tenosynovitis?

In Acute Stage
  • Provide a variety of hand splints to support the thumb and the wrist
  • Help identify aggravating activities and suggest alternative postures
  • Massage
  • cryotherapy (eg, cold packs, ice massage) to reduce the inflammation and edema
  • ultrasound (ie, phonophoresis) or electrically charged ions (ie, iontophoresis)
  • suggest activity modifications
In Chronic Stage
  • Thermal modalities
  • Transverse friction massage
  • Cold laser treatments are becoming more common with a high success rate for reducing localized swelling of tendons (tendonitis). More and more physical therapy and hand centers are finding this modality to be useful for De Quervain's syndrome.
  • Splinting
  • Sensory evaluation
  • Therapeutic exercises — Starting with ROM exercises, and as the patient progresses, adding strengthening exercises
  • Ergonomic workstation assessment as needed
  • Educating the patient to either avoid or decrease repetitive hand motions, such as pinching, wringing, turning, twisting or grasping and
  • A home-exercise program

 


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