Thumb/Wrist Pain? It could be De Quervain's Tenosynovitis.
De Quervain’s Tenosynovitis is a painful condition which affects the thumb muscles (Abductor Pollicis Longus and extensor Pollicis Brevis).
Commonly seen in females who are in the post-natal phase, it is caused by a rapid increase in load on the thumb muscles and tendons. This over-load is usually caused from repetitive feeding positions, lifting and holding of an new infant. It can also commonly occur in golfers.
Symptoms will include swelling and local tenderness over the tendons. It can also be a sudden sharp feeling, which is not ideal when holding a young child!
It is diagnosed by conducting a simple test called the Finkelstein test. The tests involves bending your thumb across the palm of you hand and then bending your fingers over the thumb. The wrist is then bent toward your little finger. If this reproduces the same pain you experience, it is likely De Quervains syndrome.
A physiotherapist will also conduct some tests on the joints around the thumb and wrist to exclude them as a source of the symptoms.
Successful treatment techniques include splinting/bracing of the wrist to off-load the thumb tendons, and then progressive weaning from the brace to reintroduce load in a monitored way.
Gradual strengthening of the tendon is highly important as increasing the tendons tolerance to load is the fundamental component of rehab. As with any tendon strength program, load needs to be slowly introduced as a sudden increase in strength exercises can easily overload and aggravate the tendon! If bracing is left on for too long the tendon will become weaker and hence when you remove the brace the pain will come back.
If you start treatment early, your symptoms should improve over the next 4-6 weeks. If your symptoms start during or after pregnancy your symptoms are likely to resolve once breast feeding has stopped.
Despite common belief, a corticosteroid injection is not the first line treatment. An injection should only be considered if bracing and physiotherapy has failed over a 4-6 week period.
ICE for pain relief
BRACE to off-load the tendon
STRENGTH to increase the tendons tolerance to load (likely the reason the thumb was sore in the first place).
CORTISONE injection only after 6 weeks if the above fails.
If you have any questions or if you think you may have De Quervain's then please do not hesitate to get in touch with us here.