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De Quervain’s Tendinitis Hand Therapy

De Quervain's (dih-kwer-VAINS) tendinitis is a condition that causes pain and tenderness at the thumb side of the wrist, at the base of the thumb and forearm.

This particular pain is aggravated when/with grasping or extending the thumb (pulling it back like "giving a thumbs up sign and then using the same thumb to point to your chest").

Unfortunately, anyone at any age can develop this painful thumb and wrist condition, and it occurs when the tendons are strained by

• prolonged or repetitive use of the hand
• rapid or forceful hand use or
  
• use of the hand or arm in an awkward position

These wrist and thumb tendons becomes

• damaged
• irritated
• inflamed

at the wrist, and causing pain and thickening over time.

Common forms of treatment for De Quervain’s include

• hand therapy
  
• customized splinting
  
• ultrasound therapy
• heat therapy
• cold therapy
• range-of-motion exercises

Injection for cortisone by a doctor is common treatment. Persistent and unresolved cases may require hand surgery. We can refer you to an orthopedic surgeon in our medical network as well as part of our value-added service.

first of all, What is De Quervain’s Tendinitis?

De Quervain's tendinitis is a common condition involving tendons of the wrist.

Tendons are tough cords or bands of connective tissue that connects our muscles to bones. The thumb and wrist extensor tendons (Abductor Pollicus Longus and Extensor Pollicus Brevis) are encased in a tunnel-like "sheath" at the wrist, which keeps the tendons in place.

De Quervain's tendinitis can occur gradually or suddenly, when the tendons become inflamed or thickened from overload or repetitive use, and have difficulty sliding through the extensor tunnel.

Risk factors for developing De Quervain's tendinitis include:

• Chronic overuse of the hand
• Excessive use of the thumb from texting and gaming
• Being female (women are 8 to 10 times more likely to develop this condition than men)
• Pregnancy
• Using the hand or arm in a position that feels awkward
• Participation in sports that stress the hand and wrist, such as golf and tennis
• Age 40 years and above
  
• Race; members of the black community may be more likely to experience this problem

How Does De Quervain’s Tendinitis Feel like?

A person who has De Quervain's tendinitis may:

• Feel localized tenderness, pain, and, swelling at the wrist near where the thumb is attached to the forearm
• Have difficulty pinching or grasping with the thumb or hand
• Feel pain when moving the wrist from side to side or twisting it
• Experience limited motion and feeling of weakness in the thumb
• Have difficulty flexing the thumb
• Notice a "catching" or "snapping" sensation with movement of the thumb (a less common symptom)

Active use of the hand with activities, such as writing, opening jars, lifting a child, hammering, sports, and any workplace or home activity that involves pinching or grasping with the thumb, can provoke the symptoms of

• pain
• stiffness
• weakness

How Is De Quervain’s Tendinitis Diagnosed?

Our senior hand therapists will ask you how and when you first experienced symptoms, and what it feels like at the present time.

They will perform a physical exam that will include

• feeling for tender spots
• measuring the flexibility and range of motion of the thumb and wrist
• testing the strength of the thumb muscles and grip

They will also perform a Finkelstein test, which gently stretches the tendons on the thumb side of the wrist through the extensor tunnel. Pain during this test is common with De Quervain’s tendinitis.

Our senior hand therapist will also perform other tests to rule out any underlying conditions that may mimic De Quervain's symptoms.

how our senior hand therapist can help

If our senior hand therapist confirms De Quervain’s Tendinitis from an evaluation, they will work with you to develop an individualized plan with you for this condition.

They will review and evaluate how you use your hand and wrist for functional activity. The review will include your daily activities, work, and sports activities. They will try to help you identify what activities or positions that you use that may contribute to the problem. They will also instruct you how to make changes in your function to help healing and reduce risk of the problem in the future.

Specific instructions may include

• avoiding repetitive thumb and/or wrist movements
• avoid flexing the thumb
• avoid moving the hand toward the pinkie finger as much as possible
• avoid forceful hand movements
• avoid any movements or activities that increase pain

Our senior hand therapist may provide a customized wrist splint to position your wrist and thumb for rest, and to provide compression to provide pain relief and decrease swelling.

They will also work with you to reduce pain and inflammation.

Ultrasound therapy may be applied to accelerate soft tissue healing and improve pain. This treatment uses ultrasonic sound waves applied over the involved area to

• improve circulation
• reduce swelling
• aide healing of the tissues and tendons

Iontophoresis is another option to reduce swelling and pain. Iontophoresis is a type of electrical stimulation that is used to administer medication to the problem area through your skin.

Cold therapy and heat therapy may be recommended for short term pain relief. Our senior hand therapists will advise you for what is best for your condition.

Exercise is prescribed to improve range of motion and prevent stiffness. Early on, exercise is restricted to avoid aggravating the condition. As the condition improves, exercises will be progressed to improve strength for functional activity, as well as improve active range of motion of the thumb and wrist.

If your symptoms do not respond to conservative care, we will refer you to an orthopedic doctor who will determine if you need medication, injection, or surgical care for further recovery.