What is it?
De Quervain’s syndrome is named after the Swiss surgeon Fritz de ‘Quervain, who identified it first in 1895 (Pagonis et al 2011). De Quervains is described as an inflammation of the sheath that surrounds two tendons that control thumb movement (Hassan et al 2012). The main cause of De Quervains is repetitive thumb movements in combination with radial deviation of the wrist such as pinching, wringing, lifting and grasping movements. These movements can cause the tendons of the Extensor Pollicis Brevis (EPB) and Abductor Pollicis Longus (APL) to press against the styloid process which can cause friction and irritation of the tendons. The tendons swell, reducing the space in the tunnel (Van Dongen et al 2002).
What Causes it?
The most common cause of De Quervains is chronic overuse. Activities such as golfing, fly fishing, carpentry, office workers, musicians, and carrying a child in the arms for long periods can lead to chronic overuse injuries. Other causes include direct trauma leading to scar tissue formation, or inflammatory arthritis. De Quervains is most common between the ages of 30-50. It is also more common in Women postpartum (Gonzalez-Inglesias 2010).
What are the Signs and Symptoms?
The primary symptom is wrist and thumb pain that radiates up the forearm when gripping or extending the thumb. The pain has been described as a “constant aching, burning” sensation (Walker 2004). It is often worse with repetitive lifting, gripping, or twisting motions of the hand. There can also be swelling and tenderness around the thumb and wrist. Other symptoms can include reduced movement, weakness and numbness in the hand (Gonzalez-Inglesias 2010).
How can I Manage De Quervains?
In rare cases De Quervains does require surgery but usually it can be treated with a non-surgical approach. This will include immobilizing your thumb and wrist with a splint or brace to help your tendons rest (Gonzalez-Inglesias 2010), avoiding movements that are repetitive or cause more pain, and using ice to reduce inflammation.
How Can Physiotherapy Help?
If you suspect you have De Quervains come along to Bodyworks Edinburgh where one of our physiotherapists can help treat you. A Physiotherapist will be able to diagnose your De Quervains with a thorough examination. This will include gathering a detailed history, looking at your range of movement, strength and doing special tests to confirm De Quervains.
Physiotherapy can be very beneficial for anyone with De Quervains. A Physiotherapist will show you how to modify activities to reduce pain. They can show you how to stretch and strengthen the muscles around the thumb (Papa 2012). Deep tissue massage around the thumb can also be beneficial.
Get in touch if you think you may have this or if you have any questions.
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Gonzalez-Inglesias, J., et al. 2010. Differential Diagnosis and Physical Therapy Management of a Patient With Radial Wrist Pain of 6 Months Duration: A Case Report. Journal of Orthopedic Sports Physical Therapy.
Hassan, M.K., Rahman, M.H,. 2012. Role of Ultrasound In The Management of De’Quervain’s Disease. Medicine today.
Pagonis, T., and Ditsios, K., 2011 . Improved Corticosteroid Treatment of Recalcitrant de Quervain Tenosynovitis With a Novel 4-Point Injection Technique. American Journal of Sports Medicine.
Papa, J.A. 2012. Conservative management of De Quervain’s stenosing tenosynovitis: a case report. Journal of Canadian Chiropractic Association
Van Dongen, L.M., PILON, J.H.J., 2002. Handbook for hand rehabilitation and practice. Houten/Mechelen.
Walker, M.J., 2004. Manual Physical Therapy Examination and Intervention of a Patient With Radial Wrist Pain: A Case Report. Journal of Orthopedic Sports Physical Therapy.