De Quervain's tenosynovitis

Synonyms for De Quervain's tenosynovitis:

• Thumb tendinitis
• Tendinitis at the base of the thumb
• Extensor tendinitis of the thumb
• Thumb or De Quervain's tendinopathy

What is De Quervain's tenosynovitis?

It is an inflammation of the fluid within the sheath of the tendons at the base of the thumb.

What is a tendon?

A tendon is the structure that attaches the muscle to the bone. When a muscle contracts, the force is transmitted to the tendon, and the tendon stiffens to move the bones.

The thumb tendons need to pass through sheaths to slide smoothly. The fluid in these sheaths can become inflamed, which causes this injury.

What are the causes of De Quervain's tenosynovitis?

Tenosynovitis can be caused by:

• Repetitive wrist or thumb movements
• Overload on the wrist or thumb
• Direct trauma to the thumb
• Inflammatory arthritis (see inflammatory arthritis section)

Note that the source of pain in De Quervain's tenosynovitis is often the radial nerve (see arm neuralgia section)

Here are some classic examples of the development of this pathology:

• A new mother or father who lifts their baby dozens of times a day with the same twisting motion of the wrist. With repetition, this type of injury can develop.
• Someone who starts renovations at home and does a lot of hammering.

What are the symptoms of De Quervain's tenosynovitis?

In general, the pain appears gradually.

The main symptoms are:

• Pain at the base of the thumb (may also be present at night)
  
  • The pain is often described as dull, tight, pulling, or burning.
• Pain that may radiate to the wrist or forearm
• Loss of strength in the wrist and hand
• Difficulty performing the following actions:
  
  • Opening a jar
  • Picking up an object with an open hand
  • Texting on a cell phone
  • Holding a book for a long time
  • Holding a child in your arms
• Sometimes, there may also be swelling at the base of the thumb and crackling sounds during thumb or wrist movements.

How is De Quervain's tenosynovitis diagnosed?

Diagnosis is made based on a review of your symptoms and a clinical examination.

When should you see a physiotherapist for De Quervain's tenosynovitis?

You should consult a physiotherapist if you have symptoms as described above or if your doctor has already ruled out any other cause that may be responsible for your pain.

You do not need to see a doctor before consulting a physiotherapist. If your condition requires you to see a doctor, your physiotherapist will be able to tell you.

What physiotherapy treatments are available for De Quervain's tenosynovitis?

Your physiotherapist will perform an assessment to determine the cause of your De Quervain's tenosynovitis by evaluating the following elements:

• Your joint mobility
• The gliding of your nerves
• Your postural habits
• The quality of your movements
• Your strength and stability

Based on the assessment results, your physiotherapist will:

• Mobilize the joints, muscles, and nerves that are affected to reduce pain and improve movement
• Give you specific exercises to do at home to address the cause of the problem and relieve pain
• Teach you how to properly manage your daily activities and hobbies to optimize healing
• Will give you advice for your movements.

What to do at home for De Quervain's tenosynovitis?

Temporarily stop doing the movements that cause too much pain, and then gradually start doing them again. Here are some other tips that may help:

• Sometimes, wearing a temporary splint or taping to support the thumb can help reduce pain.
• If you have pain at night or morning stiffness, make sure your neck is well supported while sleeping with a pillow that fills the hollow of your neck.
• Avoid sleeping with your arm behind your head or under the pillow. Keep your arm along your body or supported with a pillow.

If you don't see any improvement after 10 days, you should consult a physiotherapist.

Sources

• Anderson SE, Steinbach LS, De Monaco D, Bonel HM, Hurtienne Y, Voegelin E. “Baby wrist”: MRI of an overuse syndrome in mothers. American Journal of Roentgenology. 2004 Mar;182(3):719-24.
• Ashurst JV, Turco DA, Lieb BE. Tenosynovitis caused by texting: an emerging disease. The Journal of the American Osteopathic Association. 2010 May 1;110(5):294-6.