Wrist pain - Management of De Quervain’s Tenosynovitis

De Quervain’s tenosynovitis is a condition involving two of the tendons that move your thumb. It presents as an ache on the thumb side of the wrist and, left untreated, can result in significant pain, swelling and reduced function of the thumb. Physiotherapy can be an effective conservative treatment option in the management of De Quervain’s.

WHAT DOES TENOSYNOVITIS MEAN?

Tenosynovitis refers to inflammation or thickening of the synovial sheath surrounding a tendon, which can lead to pain. In the case of De Quervain’s, there are two tendon’s involved – the tendons of the Extensor Pollicis Brevis (EPB) and Abductor Pollicis Longus (APL). It is debated whether or not De Quervain’s is inflammation of the synovial lining, or through degeneration which leads to fibrous tissue deposits on the tendon sheath, leading to thickening.

WHAT CAUSES IT?

In many cases, the true cause is not known. However, the onset is most frequently related to overuse of the involved tendons, or a sudden increase in load demand on the tendons.

Traditionally, De Quervain’s was most common in the over 40’s population, however, it has become much more common in the younger population as a result of the excessive use of mobile phones and gaming, placing high demand on the thumb. A 2019 study of 500 school students found a 49% incidence of De Quervain’s among the students. They found that prolonged gaming and mobile phone usage was associated with a higher risk of De Quervain’s tenosynovitis.

The condition is also quite common in post-partum women, which is thought to be due to a combination of a rapid change in hormones, as well as a sudden change of demand on the wrists through holding, lifting, feeding the newborn child.

WHAT ARE THE SYMPTOMS?

The main symptoms are pain, tenderness +/- swelling on the wrist near the base of the thumb. Typically, actions such as gripping, pinching, opening a jar or wringing can increase the pain. The Finkelstein’s test is the most common diagnostic test used. It involves holding the thumb at the palm with the fingers closed over, then bending the wrist towards the little finger. If pain increases at the base of the thumb, this test is considered to be positive.

WHAT ARE THE TREATMENT OPTIONS?

Physiotherapy treatment for De Quervain’s tenosynovitis may include:

Rest – in the initial acute stage, it is important to limit any aggravating movements to allow the inflammation of the tendon sheath to settle. Often, splinting of the wrist and thumb is used to limit any movement at the wrist of thumb, allowing complete rest of the tendons in a neutral position.
Exercise therapy – Once symptoms have settled in the initial stages certain exercises can help to improve the load tolerance of the tendons and avoid a recurrence of symptoms. They can also help to improve tendon gliding within the wrist.
Manual Therapy – May be used as an adjunct to therapy for pain relief.
Onward Referral – may be required if you would benefit from specialist involvement such as a hand therapist or consultant.

Other treatment options include:

NSAID’s – non steroidal anti-inflammatory drugs are often used to manage pain and to reduce inflammation. It is important to check with your GP or pharmacist before commencing anti-inflammatory medication.
Steroid Injections – As a more invasive option, steroid injections may be an option if conservative physiotherapy treatment has failed. Your physiotherapist can provide you with a referral for your GP to arrange this.
Surgery – Surgery is a last resort option as it is the most invasive.

ARE YOU SUFFERING FROM PAIN ON THE THUMB SIDE OF YOUR WRIST?

If you or someone you know are suffering from the symptoms described, you can contact your nearest Optimum Health Solutions clinic and book in with one of our experienced Physiotherapists