De Quervain's Tenosynovitis

De Quervain’s Tenosynovitis is a painful, inflammatory condition which affects the tendons located at the base of the thumb. Commonly as a result of overuse activities such as repetitive gripping, grasping or wringing of objects, people develop pain at the base of the thumb which becomes noticeable with some thumb and wrist movements. 

De Quervains affects women more than men, particularly between the ages of 40-50 years and is fairly common in new mothers. It affects the extensor pollicis brevis and / or the abductor pollicis longus muscle as they pass through a fibrous-ossus tunnel heading towards the base of the thumb. In some instances where pain in high, there may be some evident swelling over this tendon at the base of the thumb with some symptoms of clicking.

People who are experiencing symptoms of De Quervain’s typically report:

• A history of overuse / trauma

• Repetitive movements of the upper extremity during work based activities or activities of daily living (ADL’s)

• Hand affected is dominant hand

• Possible pregnancy / post partum

• Pain ++, particularly at the base of the thumb, described as a constant ache, burning or pulling which is often aggravated by repetitive lifting, gripping or twisting movements of the hand.

Diagnosis

Once a thorough history has been achieved, a physical examination usually identifies:

• Possible swelling over the base of the thumb / anatomical snuffbox

• Tenderness on palpation of the tendons at the base of the thumb

• Decreased thumb range of movement

• Decreased wrist range of movement.

• A positive Finkelsteins’s test

The aim of physiotherapy in those with De Quervains is to reduce pain, swelling and increase functional use of the hand. Physiotherapy interventions usually include:

• Advice / Education

• Pain relief

• Ice / Heat for symptom modification

• Activity modification

• Thumb splinting

• Therapeutic Ultrasound

• Graded thumb and wrist range of movement

• Gradual reintroduction of provocative movements / activities