De Quervain’s
De Quervain’s – What is it?
Have you ever heard about de Quervain’s? If you have, chances are unfortunately you’ve experienced it yourself or know of someone who has. I can speak from first hand experience about dealing with this injury as I have recently just recovered from it myself. So what exactly is it?
De Quervain’s Defined
De Quervain’s commonly known as de Quervain’s tendinosis/ tenosynovitis is when the tendons around the base of the thumb are irritated or constricted. The terms “tendinosis” and “tenosynovitis” refer to swelling of the tendon or inflammation of the lining of the sheath surrounding a tendon (the cord that joins muscle to bone). Swelling of the tendon and tendon sheath can cause pain and tenderness around the thumb side of the wrist. In essence it affects one’s ability to move the thumb.
de Quervain's is when the tendons around the base of the thumb are irritated or constricted #performbetter @pogophysio Click To TweetA Little History
In 1895, a Swiss surgeon, Fritz de Quervain, published five case reports of patients with a tender, thickened first dorsal compartment at the wrist. Thus it was named de Quervain’s. It used to be referred to as “mother’s wrist” for the reason being that a lot of new mothers would carry their babies on the side of their hip stabilising and bearing the weight of the child all on their wrist. This position would often be repeated or held in a static position causing a flare up of the tendons. It also used to be called “washerwoman’s sprain” which is pretty much self-explanatory. Now with the jump in technology, some people know it as “Blackberry thumb” from all the typing and texting on small handheld devices. Although you may be thinking I suffered de Quervain’s from being a mother or constant texting think again. For one I am not a mother yet and two I try to stay away from being glued to my mobile phone.
Anatomy
The hand is made up of an intricate system of tendons and muscles. Tendons are rope-like structures that attach muscle to bone. The tendons are covered by a soft-tissue layer that allows the tendons to easily slide through a fibrous tunnel called a sheath. Therefore any swelling or thickening of the sheath will cause irritation and friction with certain thumb movements.
The hand is made up of an intricate system of tendons and muscles. #performbetter @pogophysio Click To TweetWith de Quervain’s there are two main muscles that are involved. Under the first dorsal compartment located at the base of the thumb, you will find the tendons for the abductor pollicis longus (APL) and the extensor pollicis brevis (EPB) muscles. These muscles help spread and extend the thumb away from the hand.
Signs and Symptoms
- Pain felt over the thumb side of the wrist
- May occur “overnight” or very gradually radiating pain into the thumb or forearm
- Most notable when forming a fist, pinching, grasping or twisting
- Swelling over the base of the thumb
- A “catching” or “snapping” sensation when moving the thumb
- Positive Finkelstein’s Test
Management
Conservative Treatment: Treatment options vary depending on the severity of the condition but more than likely your doctor would recommend some of the following options:
- Immobilisation: Splints may be used to rest the wrist and thumb
- Ice: Applying ice to the affected area may help with the pain and swelling
- Medication: Non-steroidal anti-inflammatory medications (NSAID’s) may be prescribed to decrease the swelling and discomfort
- Physiotherapy: Physios can help instruct you on exercises, taping techniques and ways to decrease stress to the area
- Injections: Corticosteroids injections to the affected tendon sheath may be done to relieve local inflammation and pain
Surgical Treatment: If all conservative options fail and symptoms do not improve, surgery may be recommended. The goal of surgery is to open the tendon sheath to allow room for the irritated tendons to glide.
Regardless of the treatment, normal function of the hand can resume once comfort and strength have returned.
If you have any further questions be sure to visit your local physiotherapist and they can assist you to the best of their ability.
Natasha Chan (APAM)
Physiotherapist
References:
De Quervain’s Tendinosis-Orthoinfo – AAOS. Orthoinfo.aaos.org. N.p., 2016. Web. 01 July 2016. Retrieved from: http://orthoinfo.aaos.org/topic.cfm?topic=a00007.
De Quervain’S Stenosing Tenosynovitis. 1st ed. Thibodaux, LA: The Louisiana Hand and Elbow Center, 2016. Print.
De Quervain’S Tenosynovitis Sydney NSW. Handsurgery.com.au. N.p., 2016. Web. 01 July 2016. Retrieved from: http://www.handsurgery.com.au/services/de-quervains-tenosynovitis/.
Griffin LY (ed): Essentials of Musculoskeletal Care, 3rd Edition. Rosemont, IL. American Academy of Orthopaedic Surgeons, 2005.
Keynoosh Homayouni, Leila Zeynali, and Elaheh Mianehsaz, J. Musculoskelet. Res. 16, 1350019 (2013) [6 pages] DOI: http://dx.doi.org/10.1142/S021895771350019X.
