De Quervain's Tenosynovitis

Pathophysiology

De Quervain’s Tenosynovitis is an irritation of the outer layer of the tendon which controls thumb movements. Commonly affects young mothers, thought to be due to hormonal changes and repetitive lifting or can be a result of a direct blow to the area.

Symptoms

  • Pain over the outside of the thumb, tender to press
  • May have swelling of the tendon
  • Pain on thumb movements
  • Pain on resisted thumb movements
  • Pain on gripping and lifting tasks
  • May hear clicking or snapping of the tendon

Management

  • Activity modification
  • Ice or heat
  • Pain relief
  • Physiotherapy including range of movement, strengthening exercises and splinting
  • Orthopaedic options include steroid injection or surgery if symptoms do not improve with conservative measures

Investigations

  • If symptoms do not settle with conservative management within 3 months steroid injection may be offered or if this fails surgery may be considered

Exercises to try:

Isometric Thumb Extension

Isometric Thumb Extension

With your thumb facing the ceiling 

Place a finger from the other hand on top of the thumb

Press one into the other and hold for 30-45 seconds

Isometric Thumb

Thumb Isometric Adduction

With your thumb facing the ceiling

Place a finger of the other hand next to the thumb

Press one into the other and hold for 30-45 seconds

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