Let's talk about De Quervain's tenosynovitis today!
Do you have pain and possibly swelling at the wrist region near the base of your thumb? Maybe it radiates up the forearm a little bit also, especially when you’re using your hands a lot?
What about pain while texting or typing, opening a jar, lifting your child or grandchild, or gripping something hard?
All of these things may be due to a tendon injury in the wrist called De Quervain’s wrist tenosynovitis.
I know those are all fancy words that probably make zero sense so here’s the breakdown. It’s an overuse injury of the two tendons that run from the wrist to the base of the thumb.
As a physical therapist, I’ll say that this is a fairly common injury in people who work with their hands all day or were in a traumatic car accident (in which they gripped the steering wheel really hard during impact).I’m sure you’re ready to get over this injury and get back to feeling better and doing normal daily activities without that nagging pain. So let’s dive deeper into this wrist tendonitis type of injury so you better understand it. (See Related: About Me)
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What is De Quervain’s Wrist Tenosynovitis?
De Quervain’s tenosynovitis is an overuse injury to two tendons at the base of your thumb which I’ll go into detail about later. [See MayoClinic for more info]
Some common symptoms include feeling a throbbing pain, a sticking feeling when the thumb moves, swelling, possible radiating pain up into the forearm, and pain with thumb and wrist movement including gripping. Also, due to the potential swelling, you may hear or feel a creaking with movements as the tendons slide through the sheath.
Common Causes of DeQuervain’s Wrist Tenosynovitis
What often happens is there can be overuse as a result of repetitive activity or microtrauma due to something traumatic. In my clinic, the cause I heard most was a traumatic car accident. Another patient did a lot of gripping and lifting at work loading suitcases on and off planes all day, so his had developed over time.
But I also had some new mom’s that experienced it due to the new, repetitive lifting of their baby that they weren’t used to. It makes sense why another name for this injury is being coined “mommy’s thumb.”
Women are 3x more likely than men to develop De Quervain’s tenosynovitis of the wrist aka “mommy’s thumb” due to repetitive lifting of their newborns. But both men and women can experience this injury.
In addition, certain hobbies that involve repetitive wrist movement can bring on this injury like racquet sports, throwing sports, video gaming, and more.
I can’t wrap up this section without mentioning the impact of technology on this injury. It’s becoming more and more common as more of us are on our phones and tablets throughout the day. The increased use of these devices is leading us to use our wrists and thumbs more than ever, making us more prone to this injury. Texting thumb, anyone?
Location & Muscles Affected by De Quervain’s Wrist Tenosynovitis
These are the two muscles and tendons that are affected:
Abductor pollicis longus (APL)
Extensor pollicis brevis (EPB)
If you hold your hand up in front of you and then raise your thumb out away from the other fingers, you’ll see those tendons pop up and a little hole or divot will form beside it (called the snuff box). Those are the tendons affected.
As these tendons go through the wrist, they go through this little tunnel or sheath that is part of the extensor retinaculum. So within this sheath, some friction can develop in that area with repetitive activity causing a thickening of the lining and retinaculum leading to less space for the tendons. So each time they glide through the tunnel, pinching occurs causing pain - ouch!
Hence the name tenosynovitis which means inflammation of the fluid-filled sheath (synovium) that surrounds the tendon.
Testing for De Quervain’s Wrist Tenosynovitis
Testing for rotator cuff tendonitis typically begins in Physical therapy with some range of motion (ROM) tests, manual muscle selective tissue tensioning tests (testing tendon strength), muscle length tests (testing flexibility), manual muscle testing, palpation tests, and special tests.
How to Test De Quervain’s Wrist Tenosynovitis: The most widely used test for this injury is called Finklestein’s Test and it’s one that you can easily do on your own at home. I’ve included a video teaching you how in the treatment section below, so keep reading.
Typical test results: tenderness to palpation, decreased and painful flexibility, decreased active range of motion, strong but painful tendon strength testing, decreased thumb and grip strength, and possible swelling.
The two thumb muscles involved do these main actions: adduct and extend the thumb which bring the thumb in toward the rest of the hand.
De Quervain’s wrist tenosynovitis is often easily diagnosable with the tests above. So from there, it’s typically suggested you perform 6-8 weeks of Physical therapy. Then if there is no improvement, your Physician may suggest further testing like getting an Xray, MRI, or ultrasound to determine if there is more extensive damage. You may also be given a splint to rest the tendons further.
Conservative Treatment for De Quervain’s Wrist Tenosynovitis
Disclaimer: The information provided is not intended to be a substitute for professional medical advice, diagnosis or treatment. Never disregard professional medical advice, or delay in seeking it, because of something you have read on this website. Never rely on information on this website in place of seeking professional medical advice.
Now that you better understand what this wrist tendonitis is, what causes it, and which muscles are involved let’s now cover what you’re likely most interested learning about: treatment for De Quervain’s wrist tenosynovitis.
Physical therapy treatment should always be 100% customized to you: the stage of your injury (recent/acute or chronic), your history, your activity level, your job, your impairments, your abilities, and your goals.
With that said, the below treatments are general treatments often prescribed by Physical therapists for wrist tenosynovitis. Always consult your Physician before beginning any new exercise program.
Treatments for De Quervain’s Wrist Tenosynovitis (from basic to advanced):
Rest (less or modified repetitive aggravating activity)
Joint mobilization (level depends on stage of injury; plus mobilization with movement (MWM))
Range of motion exercise (without a pain-free range)
Stretching (plus contract-relax technique)
Strengthening exercise (including isometrics)
Manual/Massage: soft tissue massage, deep tissue massage, cross friction massage (if not an acute injury), dry needling
Modalities: Ice, Ultrasound
Ergonomic training while using computer (see ergonomic mouse pad below)
Splint (if prescribed and more severe)
If those conservative treatments don’t help then PRP injections, corticosteroid injections, or even surgery may be needed (especially if there are other tears or more severe injuries included).
Below are some products from Amazon that are often useful for addressing De Quervain’s wrist tenosynovitis pain:
Physical Therapy Exercises for De Quervain’s Wrist Tenosynovitis
In the following videos, I share how to test for De Quervain’s wrist tenosynovitis, how to feel for tenderness, how to improve range of motion for the wrist and thumb, how to stretch the wrist and thumb, how to improve thumb mobility, and finally some strengthening exercises.
The Best Exercises for De Quervain’s Tenosynovitis
Mission: Mobilize, Modify, Move
It’s my goal to ensure you learn three things with every blog post: how to mobilize your body, how to modify exercise, and how to optimize your movement.
Above I shared a video for dynamic wrist and thumb mobility and stretching. I also shared some great grip strengthening and thumb exercises. Strengthening the wrist and thumb helps stimulate blood flow to the muscles and tendons to help speed up the healing process.
Now, let’s cover some ideas for how to modify exercise if you have De Quervain’s Tenosynovitis:
Consider adjusting your workout split to focus more on the lower body and core more often temporarily until your wrist feels better.
Modify upper body exercises by working within a comfortable range of motion, using lighter loads, slowing things down, and adjusting your grip. For example, a dumbbell or barbell that is thicker (larger diameter) may be more comfortable temporarily then a small grip.
Throughout the day, modify any of the repetitive movements you make as that’s possibly the true cause of the inflammation. Or take more breaks while doing them. For example, if there’s a certain way you hold and feed your newborn, change up the way you hold them and the angle your wrist is at. Use pillows to help you be comfortable and not overflex or overextend the wrist. If you are typing at your computer all day, try to take a break each hour to stretch out your wrist and thumb.
Finally, if you plan to continue to strength train, I suggest you try these things out to move more optimally:
Warm-up appropriately prior to lifting. Try using a band to do some light, high rep wrist curls in each direction.
During strengthening exercises, an eccentric-accentuated focus is shown to be effective for tendonitis.
Definitely modify or skip these exercises temporarily if you have >4/10 discomfort: front squat (with wrist extended), push-ups, and planks. An easy substitution for any wrist weight bearing exercises would be using a fist or have your hands on dumbbells so you can keep the wrists in more of a neutral position.
If any of what I said is confusing or you want additional help with addressing your impairments, be sure to watch the webinar “Outsmart your Injury” to learn more about exercise modification and how you can take control of your injury instead of letting it control you. Then reach out and let’s chat!
Thanks for reading!
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