Common Thumb Pain: De Quervain's Tenosynovitis

What is de Quervain's tenosynovitis ?

De Quervain's tenosynovitis is a painful condition that involves the swelling and thickening of the tendon sheaths around the abductor pollicis longus and extensor pollicis brevis tendons, which run along the thumb side of the wrist and attach to the base of the thumb. The thickening and swelling of these sheaths cause entrapment of the tendons, resulting in inflammation and pressure on nearby nerves, leading to pain and numbness. This condition is typically caused by repetitive hand and wrist movements or overuse and is exacerbated by thumb movement and radial and ulnar deviation of the wrist. (Koehl, 2022; Allbrook, 2019)

Symptoms of de Quervain's tenosynovitis
 

• Symptoms of de Quervain's tenosynovitis include:  
• Pain or tenderness at the base of the thumb, which may develop gradually or suddenly 
• Pain that radiates up the forearm 
• Pain that worsens with thumb, hand, or wrist use, especially when forcefully grasping, lifting, or twisting objects 
• Swelling near the base of the thumb 
• Numbness along the back of the thumb and index finger 
• A "catching" or "snapping" feeling when moving the thumb 
• A squeaking sound as the tendons move within the swollen sheaths

What causes de Quervain's tenosynovitis?

De Quervain's tenosynovitis is multifactorial. There are a number of factors that can influence the symptoms, as well as the severity. These factors can include:

• Direct trauma to the wrist: T issue around the wrist may become inflamed and swollen.
• Repetitive hand or wrist movements: Activities such as working in the garden, using a screwdriver/hammer, hand-sewing, doing sports like racquetball, tennis, or golf, and even lifting a baby all involve repetitive gripping, pinching, or other wrist and hand movements. 
• Individual factors: De Quervain's tenosynovitis is more commonly seen in women, particularly pregnant women and those aged between 30-50. 
• Physical well-being factors: Inflammatory-prone conditions, such as rheumatoid arthritis, can increase the likelihood of developing de Quervain's tenosynovitis. 

Management of de Quervain's tenosynovitis

The management of de Quervain's tenosynovitis may include (Larsen, 2021; Goel, 2015):  

1. Rest: Avoid activities that cause pain or discomfort in the affected wrist and thumb.
2. Ice: Apply ice packs to the affected area to reduce swelling and inflammation.
3. Medications: Over-the-counter pain relievers such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) can help alleviate pain and reduce inflammation.
4. Splinting: Wear a thumb spica splint to immobilize the wrist and thumb and allow for healing.
5. Physical therapy: Exercises and stretches can help improve range of motion and strengthen the muscles and tendons in the affected area.
6. Injections: Corticosteroid injections can help reduce inflammation and alleviate pain.
7. Surgery: In severe cases where other treatments have failed, surgery may be necessary to release the tendon sheath and relieve pressure on the tendons.  

How can thumb stabilizers help with de Quervain's tenosynovitis? 

The thumb stabilizer can help immobilize the CMC and MCP joints, reducing the movement and stress on the inflamed tendons that cause de Quervain's tenosynovitis. (Witt, 1991) By reducing movement and stress, the inflammation and pain can decrease, allowing the tendons to heal. (Menendez,2015; Awan,2017) In addition to immobilization, a thumb stabilizer can also provide compression to the affected area, which can help reduce swelling and improve blood flow to the area, aiding in the healing process. The curved design splint of the thumb stabilizer can provide support and keep the thumb in a neutral position without restricting palm or finger movement in daily activities. 

Exercises for de Quervain's tenosynovitis

Here are some examples of rehabilitation exercises that can help with de Quervain's tenosynovitis:

• Wrist and thumb stretches: Gently stretch the wrist and thumb in various directions, holding each stretch for about 15 to 30 seconds.
• Wrist flexor and extensor strengthening exercises: Use a light weight or resistance band to perform wrist curls and extensions, focusing on slow and controlled movements.
• Thumb opposition exercises: Touch the tips of the thumb and fingers together, forming an "O" shape, and then spread them apart as far as possible.
• Grip strengthening exercises: Squeeze a soft ball or hand gripper to improve grip strength.

It is important to perform these exercises under the guidance of a physical therapist or healthcare professional to avoid further injury and ensure proper form and technique.
 

Reference

1. Koehl P, Necula R, Goyal T, Sesselmann S, Mada L, Schuh A. De Quervain's disease. MMW Fortschr Med. 2022 Nov;164(19):51-53
2. Allbrook V. 'The side of my wrist hurts': De Quervain's tenosynovitis. Aust J Gen Pract. 2019 Nov;48(11):753-756
3. Larsen CG, Fitzgerald MJ, Nellans KW, Lane Management of de Quervain Tenosynovitis: A Critical Analysis Review. LB.JBJS Rev. 2021 Sep 10;9(9)
4. Goel R, Abzug JM. de Quervain's tenosynovitis: a review of the rehabilitative options. Hand (N Y). 2015 Mar;10(1):1-5.
5. Witt J, Pess G, Gelberman RH. Treatment of de Quervain tenosynovitis. A prospective study of the results of injection of steroids and immobilization in a splint. J Bone Joint Surg Am. 1991 Feb;73(2):219-22.