De Quervain Syndrome: A Tale of Two Tendons
What is De Quervain Syndrome?
De Quervain Syndrome, also called de Quervain tenosynovitis (DQT), is a problem in people who make a repetitive motion with their hand, wrist and thumb.
The motion can be involved with pursuits ranging from trimming bushes to factory work to typing to tennis. Fritz de Quervain, a Swiss surgeon, is credited with identifying the syndrome in 1895.
Understanding how de Quervain syndrome develops can help in recognizing and treating it more effectively.
Let’s Discuss:
- What causes de Quervain Syndrome?
- Symptoms of de Quervain Syndrome
- How de Quervain Syndrome is diagnosed
- Treatment options
- Rehabilitation and recovery
What Causes De Quervain Syndrome?
Understanding the Root Cause
In DQT, the fibrous sheath surrounding two key tendons in the wrist becomes inflamed.
- Both tendons—the extensor pollicis brevis (EPB) and abductor pollicis longus (APL)—are located on the inside edge of the wrist on the thumb side.
- The sheath is like a tunnel through which the tendons travel, and it is lined with a tissue called the tenosynovium. When that becomes inflamed from overuse, the movement of the tendons within is restricted and painful.
This inflammation leads to pain and discomfort, making simple tasks difficult and sometimes excruciating.
If you’ve noticed that repetitive activities, like typing or certain sports, are causing pain along your wrist and thumb, you might be dealing with de Quervain syndrome.
Recognizing the Symptoms
Common Signs to Look Out For
- Pain and Swelling: Pain and swelling along the thumb side of your wrist are the hallmarks of de Quervain syndrome.
- Type of Pain: The pain can be sharp or aching and may be aggravated by movements involving the thumb and wrist.
- Aggravating Activities: Activities that require gripping or pinching can worsen the discomfort.
- Swelling and Tenderness: You might experience swelling around the base of the thumb and noticeable tenderness when pressing on the affected area.
- Extended Pain: In some cases, the pain might extend up the forearm or down into the thumb.
If you recognize these symptoms, it’s important to seek medical advice for an accurate diagnosis.
How is De Quervain Syndrome Diagnosed?
Diagnosis and Testing
Diagnosing de Quervain syndrome typically involves a combination of a physical examination and your medical history.
- Your healthcare provider will ask about the symptoms you’re experiencing and any repetitive activities that might be contributing to the problem.
- They will also conduct a physical exam, checking for tenderness along the thumb side of the wrist and assessing your range of motion.
- In some cases, imaging tests such as X-rays or ultrasound might be used to rule out other conditions that could cause similar symptoms.
- These tests help ensure that there are no fractures or other issues affecting the wrist and thumb.
Treatment Options for De Quervain Syndrome
Immediate Relief Measures
To relieve the pain, over-the-counter anti-inflammatory medication is usually a good start, with your physician’s approval, as is icing.
Give the tendons a rest. Avoid the activity that caused the DQT—or at least avoid performing it in the same way—along with any others that would strain the area.
These steps can help reduce inflammation and provide temporary pain relief.
Advanced Treatment Options
If the pain still does not resolve, a cortisone injection will likely help.
- Cortisone is a powerful anti-inflammatory medication that can provide significant relief by reducing swelling in the affected area.
Along with medication, a thumb-spica splint will likely be prescribed.
- This device is designed to immobilize your wrist and lower thumb joints, giving the tendons a much-needed rest.
- While the splint might feel cumbersome at first, it’s an essential tool for promoting proper healing.
- The immobilization helps to prevent further strain on the tendons, allowing the tenosynovium to recover.
Rehabilitation and Recovery
Strengthening and Healing
Once the inflammation has subsided and your symptoms are under control, your physical therapist will likely develop a program of exercises to help strengthen your wrist and improve your range of motion.
Here are some exercises that may be included in a physical therapy program for de Quervain syndrome:
- Wrist Flexor Stretch
- Wrist Extensor Stretch
- Thumb Lifts
- Radial Deviation Strengthening
- Grip Strengthening
- Opposition Stretch
These exercises are designed to gradually restore function and prevent future problems.
They should be performed under the guidance of a physical therapist to ensure safety and effectiveness.
Preventing Future Issues
Preventing de Quervain syndrome from coming back involves making thoughtful changes to your daily routines and activities.
To prevent a recurrence, our physical therapists at The Jackson Clinics will evaluate the motions that caused the DQT in the first place.
If you developed DQT at work, for instance, we will check your workstation and see how you typically sit and use your hands there (keyboarding, texting, etc.). Then we will make recommendations for healthier positions and movements.
Did you know you have Direct Access* to Physical Therapy? No referral, no problem!
What to Expect in Terms of Recovery
Positive Outlook
The good news is that while DQT can be quite painful, it is fortunately a condition that can often be treated quite successfully.
Performing the right exercises and making adjustments in your activities will likely get you back to full range of motion, free from pain.
Reach out to us to get started today!
The Jackson Clinics serves 18 locations throughout Northern Virginia.
Find one near you: https://thejacksonclinics.com/locations/