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De Quervain’s Tenosynovitis by Ebony Roberts (Physiotherapist)

What is it?

De Quervain’s tenosynovitis is a common cause of wrist and thumb pain in adults. It is characterised by pain or tenderness along the radial (thumb side) of the wrist and/or base of thumb. It affects two thumb tendons called abductor pollicis longus and the extensor pollicis brevis. These tendons are responsible for moving the thumb backwards and sideways. In De Quervain’s these tendons become trapped in the small tunnel they pass through which can cause inflammation and irritation consequently causing pain and leading to restricted movement.

 

Symptoms

Patients typically present with pain along the back of their thumb and/or wrist which may also travel up the forearm. Swelling may be evident at the base of the thumb and/or wrist.  Additionally, there may be weakness and/or reduced movement of the thumb and wrist, particularly when trying to pinch, grasp or twist. Symptoms can come on gradually or suddenly with an associated incident.

 

Risk factors

  • De Quervain’s usually affects adults between 30 and 50 years of age.
  • Females are 8 to 10 times more likely to be affected by De Quervain’s compared to Men.
  • Repeated workplace tasks that require hand or thumb movements such as wringing, grasping, pinching and squeezing.
  • Inflammatory conditions like rheumatoid arthritis
  • Hobbies like gardening, gaming, racket sports, music, drawing
  • Scar tissue from a previous injury in the same area.

 

Diagnosis

A thorough subjective and physical assessment from a Physiotherapist can determine the likelihood of De Quervain’s. The subjective assessment will include activity levels, work place and lifestyle risk factors, aggravating and easing factors and the location of pain. Whilst the physical assessment will include observation, palpation of structures, range of movement and grip strength. Your physiotherapist will also perform a Finkelstein’s test. This involves creating a fist with the hand, then tilting the hand away from the thumb. A positive result is pain on the thumb side of the wrist. An ultrasound examination may also be performed to help diagnosis De Quervain’s.

Treatment

Non-operative management aims to relieve pain and symptoms and decrease any inflammation present. During the early stages of rehabilitation your Physiotherapist may place you in a thumb spica splint to reduce repetitive loading and irritation on the area and decrease inflammation. Your physiotherapist will also discuss activity modification with you. Your GP may additionally prescribe anti-inflammatory medication to help ease pain and inflammation in the early phases.

Once the pain and inflammation has settled, you will be guided by your physiotherapist through a range-of-motion and strengthening exercise program to gradually return you to work, sport or your normal activities.  Physiotherapy treatment may also include massage, ice therapy, strapping, hands on stretching or therapeutic ultrasound.

 

Surgery is a last resort and only considered for individuals who have had the condition for a prolonged time, is severe in nature and has attempted conservative treatments with no success.

References:

Papa, J. A. (2012). Conservative management of De Quervain’s stenosing tenosynovitis: a case report. The Journal of the Canadian Chiropractic Association.  Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3364060/

Ritu. G., & Abzug. J.M. (2015). de Quervain’s tenosynovitis: a review of the rehabilitative options. American Associtation for Hand Surgery. 10(1). Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4349843/

Katechia. D., & Gujral. S. (2017). De Quervain’s tenosynovitis. Sage Journals. Doi: 10.1177/1755738017713515

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Blog by Ebony Roberts (Physiotherapist)

Carpal Tunnel Syndrome

What is it?

Carpal Tunnel Syndrome (CTS) is a painful condition involving the nerve that travels through the wrist to supply the hand and fingers (the median nerve). This nerve is compressed where it passes over the carpal bones through a passage on the palm side of the wrist due to a narrowing of the tunnel, enlargement of the tunnel contents or swelling of the wrist.

Symptoms

The onset of carpal tunnel syndrome is usually gradual and is characterised by tingling or numbness in the palm, thumb and first 2 and a half fingers. As symptoms progress a burning pain may become present and then finally weakness and muscle atrophy in the hands. This often causes a feeling of clumsiness as loss of grip and pinch strength results in frequently dropping objects.
Symptoms are generally aggravated by gripping objects such as phones and steering wheels and improve with shaking or flicking of the hand.

Risk factors

The onset of CTS occurs more commonly with increasing age, during pregnancy and in conjunction with conditions such as wrist arthritis, wrist fracture, thickened tendons, tendon inflammation and hand trauma causing swelling.

Diagnosis

CTS is often diagnosed by a physiotherapist, general practitioner or hand therapists who will complete a clinical assessment including range of motion of the wrist, strength and sensation of the wrist and fingers and grip. Palpation over the palm side of the wrist may cause pain and/or reproduction of symptoms. This will be compared to the unaffected side to highlight any differences.
A positive Phalen’s or reverse Phalen’s test is highly diagnostic as it compresses the affected nerve as it runs through the carpal tunnel.
Occasionally a nerve conduction study is required.

Treatment

A range of interventions are available for the treatment of CTS. The most successful outcomes are achieved when management is commenced early as the condition can become chronic and debilitating if left untreated.

Physiotherapy management may involve:

• Avoidance of aggravating activities
• Splinting to relieve pressure off the nerve
Tendon and nerve exercises
• Swelling management
• Strengthening of hand muscles once symptoms have subsided

A small percentage of people with CTS will require surgery. This is indicated when there is a loss of sensation or inability to contract the muscles supplied by the affected nerve.

Below are some tips of what is good hand posture and some exercises that may assist with Carpal Tunnel Syndrome.

Correct Hand Posture

 

Carpal Tunnel Exercises

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Blog by Deana Gheri (Physiotherapist)

De Quervain’s Tenosynovitis

What Is it?

De Quervain’s Tenosynovitis (also referred to as radial styloid tenosynovitis) is a painful condition affecting the tendons on the thumb side of the wrist. The condition is defined as inflammation of the synovium of the abductor pollicis longus and extensor pollicis brevis tendons as they pass at the level of the radial styloid of the wrist.

Symptoms:

The main symptoms of De Quervain’s include pain and tenderness in the wrist, below the base of the thumb. In severe cases swelling or crepitus may be present.
The pain is often felt after repeated movements of the wrist and thumb. The pain may be accompanied by local stiffness and may commence after a period of rest.

Risk factors:

The largest risk factor for developing de Quervain’s includes tasks with repetitive wrist movements often involving the thumb. Often these movements include extension or abduction (side motion) of the thumb with or without resistance.
It is a highly prevalent condition in racquet sports, ten pin bowlers, rowers and canoeists given the position of the thumb whilst gripping. Professions that require hand dexterity such as baristas and chefs often have this condition . It can also be identified in those with excessive mobile phone or tablet use due to the repetitive thumb motions whilst texting and scrolling.

Diagnosis:

De Quervain’s Tenosynovitis is medically diagnosed often by a physiotherapist or general practitioner.
The clinician will assess the range of motion of both the thumb and wrist. A strength and grip assessment will also be conducted to highlight any differences between the symptomatic and unaffected side, and as a comparison to dominate limb function.
Palpation may reveal localised pain and tenderness over the abductor pollicis longus and/or extensor pollicis brevis tendons.
A positive Finkelsteins test is a highly diagnostic test as it compromises the affected soft tissues as they pass through the wrist.
In rare cases, ultrasound or MRI investigation are utilised in the diagnosis of the condition.

Treatment:

Multiple interventions can be utilised in the treatment of de Quervain’s tenosynovitis. As the condition can become chronic and often debilitating, treatment is most successful when commenced early.
Your physiotherapist will guide the appropriate management based on your assessment findings and the severity of symptoms which may include:
– Rest from aggravating exercises
– Anti-inflammatories if advised by a doctor
– Graduated strengthening exercises (starting with static contractions and building through range with resistance)
– Stretches
– Taping or Splinting of the thumb
– Injection of corticosteroid and local anaesthetic in tendon sheath
– in rare and severe cases surgery may be necessary

At Total Physiocare Heidelberg, Reservoir, Camberwell and Footscray we treat many conditions affecting the wrist.

Book an appointment today for your assessment!

Blog by Christian Bonello (Physiotherapist)