De Quervain’s Tenosynovitis is a painful wrist and thumb condition that occurs on the thumb side of the wrist that is very common. If you are experiencing symptoms, visit our hand therapists at Action Rehab for assessment and treatment.
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De Quervain’s Tenosynovitis or Syndrome refers to the painful wrist and thumb symptoms that occur on the thumb side of the wrist. “De Quervain’s Tenosynovitis“ pain is normally due to thickening of the tendons of the Abductor Pollicis Longus (APL) and Extensor Pollicis Brevis (EPB) muscles through the forearm. As the thickened tendons pass through a tunnel (the first dorsal compartment), the constant friction causes thickening and degeneration or scar tissue (as well as inflammation) to occur to the tendon sheath itself – which in turn compresses the nerve and can cause a strong, shooting type wrist pain.
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View this video to learn how a splint assists in de Quervain’s Tenosynovitis treatment and recovery. As explained by Action Rehab founder Ben Cunningham.
The causes of de Quervain’s Tenosynovitis are still unknown however it is common in new parents particularly breastfeeding mothers (Mummy thumb, or Mummy Wrist). It is also very common in repetitive manual work tasks and office based workers who use the keyboard a lot. There may be several factors centred around repetitive work or domestic related tasks such as typing, pinching, grasping, pulling or pushing, and lifting young children. In addition to this, differential diagnoses may occur due to de Quervain’s Tenosynovitis sharing similar symptoms of radial sided wrist pain – such as an unstable wrist, particularly at the scapholunate ligament (SLL). There are recent studies that look at underlying wrist instability being a cause of de Quervain’s Tenosynovitis. SLL instability can be a contributing factor to de Quervain’s Tenosynovitis symptoms and can often be misdiagnosed as de Quervain’s Tenosynovitis itself.
In a retrospective review by Redvers-Chubb (2016), the medical records of 41 patients with de Quervain’s Tenosynovitis were analysed to determine if de Quervain’s Tenosynovitis had been a result of an underlying traumatic injury in the past, in the absence of a history of repetitive strain. 19 of these patients were found to have had a previous ligament injury or trauma, with 13 of them assessed to have “problematic” scapholunate ligaments. These results were statistically significant. Other ligaments included the 1st CMC joint and several mid-carpal ligaments. The study concludes by suggesting additional diagnostic tests should be administered to rule out ligament injuries such as the Watson’s test.
This research was congruent with a 2002 article by Linscheid and Dobyns who investigated the various ligaments of the wrist and their relationship with flexor and extensor tendons. Linscheid and Dobyns noted that injury to, or instability of the scapholunate ligament (as well as several over proximal and distal row ligaments) can redistribute load in a way that increases pressure on the tendons, leading to thickening of the tendon sheaths and degeneration. In new mothers it is known that there is a natural ligamentous loosening or laxity and this may contribute to the wrist instability that may cause de Quervain’s Tenosynovitis in pregnancy and during breastfeeding. Also, a manual worker with a repetitive job may find that they develop de Quervain’s Tenosynovitis for the same reason, wrist instability. Assessment by one of the Hand Therapists at Action Rehab will help you to understand the underlying cause of your de Quervain’s pain so that we can treat it appropriately.
O’Neill, C. J. (2008). “de Quervain Tenosynovitis”. In Frontera, Walter R; Siver, Julie K; Rizzo, Thomas D. Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation. Elsevier Health Sciences. pp. 129–132.
Redvers-Chubb, K. (2016). De Quervain’s syndrome: It may not be an isolated pathology. Hand Therapy. 21(1): 25-32.
Linscheid, R. L. and Dobyns, J. H. (2002). Dynamic carpal stability. In The Keio Journal of Medicine 51(3):140-7.
Licano, J. E. (2016). How Do Scapholunate Instabilities and Distal Radial Fractures Affect Wrist Kinematics? In Radiologic technology 88(1):84-89.
Commonly de Quervain’s Tenosynovitis can be misdiagnosed and it could be other conditions such as Scapho-lunate ligament instability so it is important to have it assessed by an expert Hand Therapist.
It is very important to have a thorough assessment of your hand, wrist, elbow and shoulder if you or your Doctor suspect that you might have de Quervain’s Tenosynovitis. At Action rehab your Hand Therapist or Physiotherapist will get an understanding of the tasks that cause you pain and where the pain is located.
You may be a new mother and there might be pain on lifting your newborn or breastfeeding or changing their nappy. Alternatively you might be a manual worker and get pain when you perform a certain manual task. As we have discussed de Quervain’s tendonitis is caused by a wrist instability and so once we have established what causes your pain then we will assess the wrist, elbow and shoulder manually.
At Action Rehab Hand Therapy we will take a strength test in a number of different arm positions to establish the stability of the wrist and hand. We will perform a Watson’s Test to ascertain if the de Quervain’s Tendonitis or de Quervain’s Tenosynovitis could be coming from an instability in your Scapho-lunate joint. Finally, we will perform a Finklestein’s test to measure how much pain there is around the radial nerve in the wrist.
De Quervain’s Tenosynovitis is a complex biomechanical condition that impacts several structures in the wrist including the Abductor Pollicis Longus and Extensor Pollicis Brevis tendons as well as the sensory branch of the Radial Nerve. Impact on these structures is described as the “symptoms” of de Quervain’s Tenosynovitis, but they are not the “cause” of the problem. The cause of de Quervain’s Tenosynovitis is often multifactorial and there remains much debate in the literature.
View the video below to learn more about why post-pregnancy, it is common for mothers to experience wrist pain on the thumb side causing de Quervain’s Tenosynovitis. As explained by Action Rehab founder Ben Cunningham.
At Action Rehab we believe it is due to the prepregnancy stability of the wrist joint. If a person has a slightly unstable wrist before pregnancy, then their chance of getting de Quervain’s Tenosynovitis during or post pregnancy is much higher. We know that during pregnancy the hormones in the body help to slacken ligaments and breastfeeding continues this process after the birth. As the baby gets bigger and heavier this puts added pressure on the wrist tendons in bathing, nappy changing and feeding in particular. With a lack of stability in the wrist ligaments then the thumb sided tendons need to work harder to lift the baby and so in some cases (not all) a nursing mother will get de Quervain’s Tenosynovitis. These symptoms often coincide with the baby’s growth and development.
Once a thorough assessment has been made by your Hand Therapist or Physiotherapist at Action Rehab then we can start to treat your cause as well as your symptoms. Remember the de Quervain’s Tenosynovitis is the “symptom” and not the cause. Unfortunately it is the symptom that generally causes all the pain. At Action Rehab we will most often start your treatment in a removable brace to rest the tendons of the wrist and provide support. A customised water resistant and removable brace will be provided at your first visit and made by your Hand Therapist. Depending on your assessment and severity of the symptoms your Action Rehab Hand Therapist will decide whether to include your thumb in the splint. We will educate you in joint protection techniques that can protect your tendons and prevent you from further traumatising your de Quervain’s Tenosynovitis. Following on from wearing your brace for pain relief, your hand therapist at Action Rehab will advise you on a strengthening and stabilisation exercise program for your wrist. This strengthening program is really important even for those patients who may have had a steroid injection to treat the de Quervain’s symptomatic pain in the wrists. At Action Rehab we focus on restoring the core stability of the wrist to stop the pain and then to prevent it from reoccurrence. Your hand therapist or Physiotherapist will help you recondition your wrist and restore your stability
Depending on your assessment and severity of the symptoms your Action Rehab Hand Therapist will decide whether to include your thumb in the splint.
See below for lightweight splint with and without thumb support.
Rarely does de Quervain’s Tenosynovitis treatment require surgery. Often surgery is required because the assessment and treatment was not appropriate at the time. Steroid injections, free weights and incorrect strengthening can actually make de Quervain’s Tenosynovitis worse in some cases and therefore require surgery. If treated soon enough and when treated with appropriate stabilisation and strengthening then surgery is not necessary. In the rare occasion where surgery may be required, your hand therapist at Action Rehab will be able to advise you on whom the most appropriate surgeon is for you to see.
Hand Therapists at Action Rehab are the experts in the care of de Quervain’s Tenosynovitis and are the hand therapists that Melbourne trusts.
Our hand therapists and Physiotherapists will take the time to assess and treat your condition, and we will tailor a specialised splinting and strengthening program to treat your de Quervain’s Tenosynovitis. Hand Therapists at Action Rehab treat hundreds of de Quervain’s Tenosynovitis patients every year and our results have proven that a strengthening and stabilisation program can assist with symptoms of de Quervain’s Tenosynovitis.
How is de Quervain’s tenosynovitis caused?
A. It is caused by an instability in the wrist that then causes the thumb sided or radial sided tendons of the wrist to over work. Repetitive tasks or lifting heavy objects can cause de Quervain’s Tenosynovitis.
How common is it?
A. De Quervain’s Tenosynovitis is very common and in fact it is more common in manual workers doing repetitive jobs than it is in mothers. In breastfeeding mothers it is the number one cause of wrist pain but can be misdiagnosed as Carpal Tunnel so proper assessment is required.
How is de Quervain Tenosynovitis related to pregnancy?
A. The ligaments in the wrist can become more lax in pregnancy and while breastfeeding and this loss of support in the wrist can mean that the tendons of the thumb and radial side of the wrist tend to work harder to lift. As the baby grows and the lifting weight increases then the pain can increase too.
How long does it take to recover?
A. Recovery often depends on how long the symptoms have been present before you seek treatment. Basically don’t delay! If de Quervasin’s Tenosynovitis is treated early then it can be controlled quickly and prevented from coming back.
Will de Quervain Tenosynovitis require surgery?
A. Generally no. Surgery is a last resort but again it is important to be assessed and treated early by a therapist at Action Rehab. Multiple steroid injections can cause scarring which in turn can make surgery more likely and not less.
Is it a serious condition?
A. De Quervain’s Tenosynovitis is a painful condition and so it is serious. Generally it is easy to treat so early treatment and strengthening and stabilisation will help control it.
Will de Quervain Tenosynovitis go away if left untreated?
A. In some cases where a mother stops breastfeeding then the ligaments can return to their “normal” stability and so the condition can “go away”. However, in most cases the problem becomes quite severe and there can be long term scarring in the sheath so it may remain long after the breastfeeding ceases. Don’t wait for it to “go away’, seek treatment with Action Rehab.
This information has been verified by Action Rehab director Ben Cunningham.
Ben Cunningham is currently the Hand Therapist at Melbourne Football Club (AFL) and the director of Action Rehab. Ben has over 20 years’ experience providing hand and upper limb therapy, including working in the United Kingdom at the Queen Victoria Hospital and as the senior clinician at the Alfred Hospital in Melbourne.