De Quervain’s tenosynovitis
De Quervain’s tenosynovitis is an inflammation of the tendons and synovial sheaths of two muscles in the forearm: the abductor pollicis longus and extensor pollicis brevis. De Quervains tenosynovitis results from repetitive friction and microtrauma causing the tendons and sheath to swell, making normal motions painful.
Predisposing movements include lifting, grasping and pinching, particularly when combined with wrist radial or ulnar deviation. These activities force the tendons to rub. Activities like gardening, knitting, cooking, playing a musical instrument, carpentry, walking a pet on a leash, texting, video gaming and sports like golf, volleyball, fly fishing and racquet sports are known culprits (2,4-6).
The condition was once known as “Washer woman’s sprain”, since wringing out wet clothes is a known trigger. (7) Lifting infants & children by placing an outstretched finger and thumb beneath their armpit has led to the nicknames of “Mommy thumb” or “Baby wrist”. This problem affects a significant number of new mothers during the post-partum period wherein involvement is often bilateral. (8,11)
Symptoms of Dequervain’s:
Symptoms include pain on the lateral aspect of the wrist. The pain may begin abruptly but more commonly is of gradual onset, increasing over weeks or months. Pain may travel towards the elbow. The pain is provoked by movement of the thumb or hand, especially forceful pinching, grasping or twisting. Visible swelling over the tendon area is common. Presence of a fluid-filled cyst in this region is possible. Patients may complain of a slight “squeaking” sound or sensation associated with movement of the wrist. Catching or snapping is possible.
Do I need imaging?
Typically the answer is no. Ultrasound is useful for diagnosing tenosynovitis and identifying the presence of an intracompartmental septum. (24-26) MRI is an alternative. Imaging of tenosynovitis patients should be reserved for those with a history of trauma or other red flags and in those who fail an initial trial of conservative care.
Initial anti-inflammatory measures may include ultrasound, cryotherapy, NSAIDs, and rest.
Patients should avoid activities that provoke pain.
Video game players and those who text should take frequent breaks and hold their wrists straighter.
Patients should limit pinching, gripping and twisting.
IASTM may be implemented judiciously to release adhesions in the associated tissues.
Soft tissue manipulation and myofascial release techniques may be needed for the affected muscles as well as the wrist extensors and brachioradialis.
Therapeutic taping may provide benefit.
Manipulation of wrist and/or cervical restrictions is appropriate. For patients who do not respond to a brief trial of conservative therapy, cortisone injection is effective in about 80% of cases (17,32)
Surgery is rarely necessary and should be reserved for patients who fail conservative treatment and cortisone injections.
At Creekside Chiropractic & Performance Center, we are highly trained to treat this condition. We are the only inter-disciplinary clinic in Sheboygan county that provides chiropractic, myofascial release, ART (Active Release Technique), massage therapy, acupuncture, physiotherapy, rehabilitative exercise, nutritional counseling, personal training, and golf performance training under one roof. Utilizing these different services, we can help patients and clients reach the best outcomes and the best versions of themselves. Voted Best Chiropractor in Sheboygan by the Sheboygan Press.
Evidence Based-Patient Centered-Outcome Focused
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4. www. physio-pedia.com/De_Quervains_Tenosynovitis, August 2013
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8. The Wall Street Journal, The Baby May Be Giving You Mommy Thumb Tuesday, December 7, 2010
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