De Quervain's Tenosynovitis: Treatment and Rehabilitation at Palms Physiotherapy & Allied Health

What is De Quervain's Tenosynovitis?

De Quervain's tenosynovitis involves inflammation of the tendons and their protective sheaths at the base of the thumb. These tendons, primarily the abductor pollicis longus and the extensor pollicis brevis, allow the thumb to move away from the hand and aid in grip. When these tendons become irritated or inflamed, it leads to pain and restricted movement.

The condition typically causes pain on the thumb side of the wrist and can make everyday activities like gripping, twisting, or lifting objects difficult. It’s most common in people who perform repetitive hand and wrist movements, such as in manual labor, texting, or certain sports.

Symptoms of De Quervain's Tenosynovitis

The symptoms of De Quervain's tenosynovitis can vary, but common signs include:

1. Pain and Tenderness

• Pain on the thumb side of the wrist, which may radiate into the lower arm or up to the thumb.

• The pain is often worsened by gripping or pinching actions.

2. Swelling

• Swelling over the tendons in the wrist and at the base of the thumb.

• The area may feel warm to the touch due to inflammation.

3. Stiffness and Limited Range of Motion

• Difficulty moving the thumb or wrist without discomfort.

• Trouble performing tasks that require grasping or twisting.

4. Finkelstein’s Test

• A common diagnostic test for De Quervain's tenosynovitis, where the wrist is bent towards the little finger while the thumb is enclosed in the palm. If it causes sharp pain along the thumb side of the wrist, it is considered a positive sign of the condition.

Causes of De Quervain's Tenosynovitis

De Quervain's tenosynovitis is often caused by repetitive movements or overuse of the thumb and wrist. Specific causes include:

1. Repetitive Motion

• Frequent gripping, twisting, or pinching, such as in activities like gardening, hammering, or using tools.

• Activities like typing, texting, and playing musical instruments may contribute to the development of the condition.

2. Injury

• An acute injury, such as a sprain or strain to the thumb or wrist, can lead to inflammation in the tendons and the development of tenosynovitis.

3. Pregnancy

• Hormonal changes during pregnancy can increase the risk of developing De Quervain's tenosynovitis, particularly in the third trimester.

4. Age and Gender

• Women between the ages of 30 and 50 are more likely to develop this condition, possibly due to anatomical factors or hormonal influences.

• It is also more common in individuals with rheumatoid arthritis or other conditions that predispose the tendons to inflammation.

Diagnosing De Quervain's Tenosynovitis

A physician or physiotherapist can diagnose De Quervain's tenosynovitis based on your symptoms, medical history, and a physical examination. The following diagnostic tools may be used:

1. Physical Examination

• The practitioner will examine your wrist and thumb for signs of swelling, tenderness, and pain.

• A positive result from the Finkelstein’s test often confirms the diagnosis.

2. Ultrasound or MRI

• In some cases, an ultrasound or MRI may be used to assess the condition of the tendons and their sheaths. These imaging tests can help rule out other causes of wrist pain and provide more detailed information on the extent of the inflammation.

Treatment for De Quervain's Tenosynovitis at Palms Physiotherapy & Allied Health

At Palms Physiotherapy & Allied Health, we take a comprehensive approach to treating De Quervain's tenosynovitis, focusing on pain relief, reducing inflammation, and restoring mobility. Treatment options include:

1. Rest and Activity Modification

• Rest: Avoiding activities that exacerbate the pain, such as heavy lifting, gripping, or repetitive thumb and wrist movements, is critical.

• Activity modification: We will guide you in using the wrist and thumb in ways that minimize strain while promoting healing.

2. Ice Therapy

• Applying ice to the affected area for 15-20 minutes every few hours can help reduce swelling and inflammation. This is particularly effective during the initial stages of the injury.

3. Splinting or Bracing

• A thumb spica splint may be recommended to immobilize the wrist and thumb, reducing strain on the tendons while they heal.

• Splints may be worn for several weeks, depending on the severity of the condition.

4. Physiotherapy and Manual Therapy

• Physiotherapy is essential to reduce pain, increase flexibility, and restore movement in the wrist and thumb.

• Manual therapy techniques such as mobilizations and soft tissue therapy can help reduce stiffness and improve circulation around the affected tendons.

• Strengthening exercises are prescribed once inflammation decreases to prevent future injury and promote long-term recovery.

5. Anti-Inflammatory Medications

• Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or paracetamol can help reduce pain and inflammation in the affected area. Your physiotherapist may provide advice on safe medication use.

6. Corticosteroid Injections

• If conservative treatments do not provide relief, corticosteroid injections may be considered to reduce inflammation directly in the tendons' sheath.

7. Surgery

• In rare cases, if the condition does not improve with other treatments, surgery may be required to release the constricted tendon sheath, allowing the tendons to move freely again. This option is typically considered only if other treatments have failed.

Recovery and Rehabilitation

Recovery from De Quervain's tenosynovitis can take time, especially if the condition has been present for a long period. The following stages of rehabilitation may be involved:

• Acute Stage: Focus on reducing pain and swelling with rest, ice therapy, and splinting.

• Subacute Stage: Gradual introduction of stretching and strengthening exercises to restore movement and prevent muscle imbalances.

• Chronic Stage: Full rehabilitation, including return to activities, functional training, and advice on avoiding repetitive movements to prevent future flare-ups.

With proper treatment and rehabilitation, the majority of patients can recover fully and return to their regular activities.

Book Your Appointment Today

If you are experiencing symptoms of De Quervain's tenosynovitis, or suspect you have this condition, Palms Physiotherapy & Allied Health is here to help. Our team will create a personalized treatment plan to manage your symptoms, improve your thumb and wrist mobility, and restore your quality of life.

• Malaga: Book here

• Noranda: Book here

Contact Us:

• Malaga: 4/637 Marshall Road, Malaga WA 6090 | Phone: 6285 6185

• Noranda: 3/36 Benara Road, Noranda WA 6062 | Phone: 9376 1443

Let Palms Physiotherapy & Allied Health assist you in your recovery from De Quervain's tenosynovitis, helping you return to pain-free function in your wrist and thumb.