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De Quervain’s tenosynovitis

De Quervain’s Syndrome is a painful injury affecting the tendons of the thumb that run along the wrist. These tendons assist in moving the thumb and wrist with the addition of controlling weight and mobility of the joint. More often, De Quervain’s Syndrome is an overuse injury due to increased forces through the tendon. Repetitive movements requiring sideways movement of the wrist while gripping the thumb (eg. hammering, drilling, pruning gardens) may make one liable to sustain to this wrist injury. This can lead to eventual thickening of the tendon and irritation that can cause pain around the thumb side of the wrist, specifically the radial styloid.

The main symptom is pain over the thumb side of the wrist or otherwise know as the radial side. It may develop suddenly or gradually with the repetitive movements. It is worse with use of the hand and thumb, especially forceful grasping, pinching & twisting. There may be swelling at the site of pain and “snapping” when the thumb is moved. Due to pain and swelling, thumb movement may be reduced. Night pain can also occur particularly in worse case situations. People may not be able to grip if this is quite sore.

The initial treatment is to see your physiotherapist straight away. A scan may be requested especially if it is thought that an injection may assist with pain relief. A splint to immobilise the wrist and thumb can be worn especially if repetitive activites are required by the patient. The splint can be worn day and night.

Symptoms:

  • Swelling over the thumb side of the wrist
  • Occasionally a snapping or catching sensation when moving the thumb
  • Difficulty grasping and holding onto objects with the thumb

Physiotherapy

Physiotherapy is an important tool in assisting with the management and identifying factors which may have contributed to De Quervain’s Syndrome. This may involve ergonomic changes or modifying tasks to reduce strain through the thumb tendons. Manual therapy, nerve glides and a splint is often prescribed to allow irritation around the wrist to settle.