De Quervain's Tenosynovitis

 

What is it?

A tenosynovitis is a condition whereby the synovium which surrounds a tendon becomes inflamed. Tendons are the thin cord like projections which taper down from the muscle bellies in order to connect to the bone. In the case of de Quervain’s the tendons involved run along the back of the forearm and into the thumb. The tendons are called abductor pollicis longus and extensor pollicis brevis. These tendons are surrounded by a synovial sheath and they pass through a ligament / bony tunnel, at the level of the wrist joint, on their way to their connection points in the thumb. It is at this point where they can become inflamed. Localised pain and swelling is usual and the tenderness can often track further up into the forearm muscles. To help fully diagnose the condition the therapist may perform a test called 'Finkelstein's test' which will passively stretch these tendons and reproduce the same pain if positive.

 

Causes

Often the cause for these types of tendon related problems is overuse or doing too much of a particularly aggravating movement. This condition is reasonably common in sports people whose activities involve a large degree of wrist movements i.e. ten pin bowlers, rowers, canoeists. Day to day activities which involve repetitive wrist or thumb movements such as ironing and typing can also result in this type of tendon irritation.
 

Treatment
 

Following a thorough examination and assessment of the presenting problem, advice and treatment may include the following:

• Electrotherapy i.e. ultrasound to reduce inflammation and pain

• Strapping / taping or thumb splints to offload the painful tissues

• Soft tissue release techniques to appropriate areas

• Mobilisation of the joints and carpal bones if restricted

• Acupuncture to restore normal muscle tone and reduce pain and inflammation

• Addressing any lower neck or upper back components which may be contributing to the problem

• Individually tailored stretching and strengthening exercise programme to restore normal function

   

In chronic or recurrent cases it may be appropriate to be referred on to see a specialist who may offer a steroid injection. In intractable cases surgical release is occasionally required.