De Quervain’s Syndrome (Tenosynovitis)

Question 1

What is De Quervain’s Tenosynovitis?

Answer 1

De Quervain’s Tenosynovitis is a condition where the tendons on the thumb side of the wrist become inflamed, causing pain and swelling. It affects the tendons of the extensor pollicis brevis (EPB) and abductor pollicis longus (APL).

Question 2

What Causes De Quervain’s Tenosynovitis?

Answer 2

It is often caused by repetitive thumb or wrist movements, overuse, or direct trauma to the wrist. Activities like lifting a baby, typing, or gardening can be triggers.

Question 3

Why Are extensor pollicis brevis (EPB) and abductor pollicis longus (APL) Tendons Vulnerable?

Answer 3

The compartment housing the APL and EPB tendons is naturally narrow. Repetitive thumb or wrist movements, like texting or lifting, increase stress, causing the tendons to rub against the tunnel walls. This irritation leads to swelling, which further tightens the space, creating more friction, inflammation, and pain.

Question 4

What Questions Should Be Asked During the Subjective Assessment?

Answer 4

• Where is the pain located? (Typically on the thumb side of the wrist).
• What activities make the pain worse? (e.g., lifting, gripping, or twisting movements).
• When did the pain start? Was it sudden or gradual?
• Do you notice swelling near the wrist or difficulty moving the thumb?

Question 5

Key Observations and Movements to Assess

Answer 5

• Look for swelling or tenderness on the radial (thumb) side of the wrist.
• Check thumb and wrist range of motion for pain or restriction.
• Assess grip strength and thumb function.

Question 6

What is the Finkelstein Test?

Answer 6

Step 1: Position the patient’s arm on the treatment table, ulnar side down, with the hand hanging off the edge. Assess pain during active ulnar deviation. A positive result is pain at the styloid process (acute phase).

Step 2: If no pain, apply gentle passive ulnar deviation to stretch the tendons. A positive result is pain at the styloid process.

Step 3: For chronic cases, grasp the thumb, passively flex it into the palm, and apply ulnar deviation. Increased pain at the styloid process indicates a positive result.

Question 7

Key Management Strategies

Answer 7

• Activity modification to avoid repetitive thumb and wrist strain.
• Use a thumb spica splint to immobilize the wrist and thumb, reducing irritation.
• Apply ice to the affected area to reduce swelling and pain.

Question 8

How thumb spica splint helps manage De Quervain’s tenosynovitis ?

Answer 8

How It Works: By immobilizing the area, the splint enforces rest for the tendons and surrounding tissues.
Why It Helps: Tendons heal more efficiently when not subjected to repetitive strain or stress.

Question 9

Early-Stage Exercises for De Quervain’s Tenosynovitis

Answer 9

• Isometric Thumb Abduction
  Purpose: Activates the thumb muscles without aggravating the tendons.
  How to Perform: Hold your hand palm-up. Press the thumb gently against resistance (like a table edge or your other hand) without moving it. Hold for 5 seconds and repeat 10 times.
• Passive Thumb Stretch
  Purpose: Reduces tightness in the APL and EPB tendons.
  How to Perform: Use your other hand to gently pull your thumb across the palm and hold for 20-30 seconds. Repeat 3-5 times.
• Radial Nerve Glides
  Purpose: Mobilizes the radial nerve, which may be irritated in De Quervain’s.
  How to Perform: Straighten your arm with the palm facing upward. Flex and extend your wrist while keeping your arm still and turn your head to the oposite side watching down. Perform 10 gentle repetitions.

Question 10

What If the Patient Doesn’t Show Progress?

Answer 10

Reassess the diagnosis to rule out other conditions like arthritis or nerve entrapment.
Ensure proper compliance with splinting and activity modifications.
Consider referring for corticosteroid injections if pain persists despite conservative management.