De Quervain’s Tenosynovitis

What is De Quervain’s?

De Quervain’s Tenosynovitis is an overuse injury that causes thickening of the extensor retinaculum. Specifically, the extensor pollicis brevis (EPB) and abductor pollicis longus (APL) tendons are implicated as they pass through the first dorsal compartment of the wrist. This fibro-osseous sheath can become inflamed by continued strain of these tendons, causing lateral wrist pain.

Currently, there is still debate over the exact cause of De Quervain’s however there are several suggested aetiologies. These include fatigue, biomechanical compression, repetitive work positions, trauma, pathogen, genetics and anatomical variations1. Furthermore, rheumatoid arthritis and somatropin exposure have been found to be other associated risk factors3.

Commonly, this condition affects women between the ages of 30 and 50 years of age and females have a 6 to 10 times higher prevalence than males. Pregnancy can place women at a great risk of developing this due to the increased fluid retention, soft tissue oedema and ligament laxity.

Common clinical presentations:

  • Pain and swelling around the radial styloid and that can radiate up the forearm
  • Pain on palpation over the first dorsal compartment
  • Describing a constant ache or burning sensation
  • Pain associated with gripping, pinching, wringing, typing or twisting movements
  • Positive pain response when the thumb is maximally flexed and then wrist is taken into ulnar deviation
  • Paraesthesia and weakness in the hand

If further investigations are required, ultrasound has been shown to be highly effective in the diagnosis3 of De Quervain’s Tenosynovitis.

Initial management:

The current evidence recommends trialing conservative treatments first. This can include:

Load management and activity modification:

• Try to avoid the aggravating activities or movement as much as possible.

• Neutral wrist positions as much as possible throughout the day. Especially when typing, sleeping, gripping, or lifting objects.

• Be mindful of thumb and wrist positions when gripping objects.

Splinting:

• A splint prevents thumb metacarpophalangeal joint flexion and wrist ulnar deviation is usually prescribed. Currently there is no consensus on the recommended length of time to splint for. This can vary significantly based on the severity of symptoms. In some more severe cases, 4-6 weeks may be the recommended time frame.

Anti-inflammatories:

• Topical or non-steroidal anti-inflammatories can be prescribed by pharmacists to help target the inflammation.

Exercises:

• Start off with neutral wrist strengthening exercises to build up the endurance of forearm muscles.

• Here are some examples of exercises that can be used:

>> Dumbbell Neutral Grip Holds

Dumbbell Grip Holds

>> Dumbbell Pronation/Supinations

Dumbbell Pronation/Supinations

>> Thumb strengthening exercises using a mix of putty, rubber bands or therabands.

• There is currently limited evidence supporting the use of exercise for the treatment of De Quervain’s. A 2020 study compared whether conservative treatment with eccentric training was more effective than the currently accepted treatment options. The results were supportive of reductions in severity of pain and wrist function5.

If there is no improvement after 6-8 weeks of other non-surgical interventions, a corticosteroid injection can be trialed as a next step. In severe cases if conservation management doesn’t work, surgery is sometimes recommended. This usually includes a surgical release of the first extensor compartment.

If you are struggling with wrist or hand pain, book in now for a consultation with one of the physiotherapists at the Double Bay or Coogee Clinic.

References:

  1. Goel, R. and Abzug, J.M., 2015. de Quervain’s tenosynovitis: a review of the rehabilitative options. Hand, 10(1), pp.1-5.
  2. Ferrara, P.E., Codazza, S., Cerulli, S., Maccauro, G., Ferriero, G. and Ronconi, G., 2020, December. Physical modalities for the conservative treatment of wrist and hand’s tenosynovitis: A systematic review. In Seminars in arthritis and rheumatism (Vol. 50, No. 6, pp. 1280-1290). WB Saunders.
  3. Ferrara, P.E., Codazza, S., Cerulli, S., Maccauro, G., Ferriero, G. and Ronconi, G., 2020, December. Physical modalities for the conservative treatment of wrist and hand’s tenosynovitis: A systematic review. In Seminars in arthritis and rheumatism (Vol. 50, No. 6, pp. 1280-1290). WB Saunders.
  4. Cavaleri, R., Schabrun, S.M., Te, M. and Chipchase, L.S., 2016. Hand therapy versus corticosteroid injections in the treatment of de Quervain’s disease: A systematic review and meta-analysis. Journal of Hand Therapy, 29(1), pp.3-11.
  5. Laszlo, F.N., Johanna, T., Reka, H.J., Andrea, M.A., Noemi, S., Agnes, S.P. and Katalin, L., 2020. Treatment of De Quervain’s tendinopathy with conservative methods. ORVOSI HETILAP, 161(11), pp.419-424
Phoebe McGeoch – BeFit Training Physio Coogee

Phoebe McGeoch – BeFit Training Physio Coogee

Phoebe McGeoch is a physiotherapist based in Coogee in the Eastern Suburbs of Sydney. Phoebe has successfully treated musculoskeletal problems on the basis of a thorough assessment and diagnosis coupled with evidence-based rehabilitation programs tailored to the needs and goals of each individual. To book a consultation, click the link below.

Sign up to our newsletter for the latest tips and tricks to stay injury free

Success! We'll keep you updated

Sign up to our blog to get all our articles delivered straight to your inbox

Success! We'll notify you when the next blog post goes live!