De Quervain’s Tenosynovitis
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By: Julia Guthart, OTR/L, CHT and Pam Wilson, OTR/L, CHT
Do you have pain at the base of your thumb or at your wrist? Are you a Gamer and use your cell phone or tablet most of the day? Have you had a baby recently or are you helping with an infant in your family? You may be experiencing a special inflammation of the tendons to your thumb.
What is De Quervain’s Tenosynovitis?
The tendons have a lubricating sheath over them that helps them glide under your skin as you move your thumb. There are two tendons involved in this tendonitis:
- Extensor Pollicus Brevis (EPB)
- Abductor Pollicus Longus (APL)
The EPB helps with extending your thumb or bringing it straight up as in the “hitch hiker” position. The APL brings your thumb outward and away from your palm like when you are opening your hand to hold a water bottle. These tendons pass through a tunnel on the back side of your wrist. If the tendons are inflamed (from repetitive use, over use, or straining from holding infant’s head) a shearing force can occur as they move through the compartment or tunnel which causes pain and swelling.
De Quervain’s Tenosynovitis
Sometimes you may notice a “bump” or “lump” at your wrist that is more elongated instead of round like a marble. It is very painful when touched, poked, or palpated. This tenosynovitis is actually a mechanical problem of the tendon sheath and tendon becoming inflamed and unable to fit through the tunnel (first dorsal compartment). Sometimes the tunnel is actually divided into two tunnels which makes that unlucky person more prone to developing this De Quervain’s Tenosynovitis.
What Causes De Quervain’s Tenosynovitis?
Repetitive motion is the primary cause for this type of De Quervain’s tenosynovitis. Motions that require bending the wrist away from the thumb while simultaneously bending the thumb into the palm are particularly problematic. Some activities that may put you into this position are; lifting wet clothing from a top load washer, reaching for dishes on a high shelf, lifting an infant from a crib with the side rail still up and very commonly new mothers holding their infants head while nursing.
How Do You Treat De Quervain’s Tenosynovitis?
Well, the old “RICE” Protocol may work, in other words:
- Rest
- Ice
- Compression
- Elevation
These are good to try initially, for a day or two. But how can you go about your day doing your work, caring for your family or home with your hand elevated and wrapped up? You can’t!
Another way to rest the area is by wearing a brace that restricts some of the motion of your thumb and stabilizes your wrist. This is a specialized splint and you are more likely to be helped with a splint if prescribed and fitted by a professional. If you are an avid Gamer, decreasing game time, can help rest the tendons. Or if you have a new baby in your life, avoiding holding baby in one arm with wrist bent and your hand holding the baby’s neck and head. Also, avoid bending wrist and pinching thumb toward fingers such as the motion of unhooking a bra.
Click to Read more about How to Reduce Swelling and The R.I.C.E. Protocol.
Modifications to Keep From Irritating De Quervain’s Tenosynovitis
Modifying the way you hold and lift objects can be the first step in relieving the discomfort. Some activities can be modified to allow you to approach lifting object with wrist in a neutral position not bent toward little finger or thumb sides);
- Squat down to lift from floor
- Move dishes to a lower shelf
- Lower the side rail of the crib to lift the baby.
Some activities are not as easily modified. To get wet clothes out of a top load washer you may need to use both hands in a clapping position to prevent straining the side of your wrist.
Medical Treatment for De Quervain’s Tendonitis or Tenosynovitis
Take over the counter anti-inflammatories per package directions for dosage. Please do not use these if told to avoid these by your family physician. Ice to the area for 10 minutes 2 times a day, may be helpful. Using Ice massage or static ice pack is up for debate. This author prefers static ice pack for 10 minutes 1 to 2 times a day while also elevating hand/wrist on a bolster or pillow.
Sometimes an injection of steroids is helpful to decrease the inflammation in the area. These should be administered by highly skilled professionals. Seek the care of a Hand Surgeon for best results.
A series of gentle stretching exercises have been proven to be effective AFTER pain and inflammation have resolved. You may be instructed in these by an Occupational Therapist, Physical Therapist or Certified Hand therapist.
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Book an Appointment with The Jacksonville Orthopaedic Institute Today!
If you have De Quervain’s Tenosynovitis or any other hand or wrist issue, the experts at the Jacksonville Orthopaedic Institute can help. To see a JOI Orthopedic Hand Doctor, call (904)JOI-2000, schedule online, or click the link below. To see a JOI Rehab Hand Therapist is 1 of our 12 locations, call (904)858-7045.