DeQuervain`s Tenosynovitis causes, symptoms, and treatments

What is DeQuervain`s Tenosynovitis?

DeQuervain`s tenosynovitis (DT) manifests as thickening and myxoid degeneration of tendon sheaths, specifically affecting the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons as they traverse through the fibro-osseous tunnel situated along the radial styloid at the distal wrist. Patients with this condition often experience exacerbated pain during thumb and wrists movements especially with radial or ulnar deviation at the wrist. DeQuervain`s predominantly affects women, particularly those in the late stages of pregnancy or post-partum period. (https://www.ncbi.nlm.nih.gov/books/NBK442005/) 

What causes DT?

• Direct injury to the thumb
• Inflammatory conditions like RA
• Overuse in hobbies, i.e. gaming
• Repetitive workplace tasks

What are the risk factors for DT?

• Parenting young children
• Working with young children
• Skiing, rowing, golf or racquet sport such as tennis
• Manual labor such as swinging the hammer repeatedly
• Hobbies such as knitting gardening or gaming
• Using smartphones or tablets 

What are the symptoms of DT?

• Pain along the back of thumb, directly over the tendons of APL and EPB
• Swelling and pain at the base of your thumb
• Swelling and pain on the thumb side of wrist
• “popping” or stiffening sensation when moving the thumb
• Popping sensation in the wrist
• Numbness
• A fluid-filled sac, called a cyst on the thumb side of wrist

The condition can happen gradually or start suddenly. In either case, pain may travel into the thumb or up to forearm. Most painful movements maybe pinching, grasping, thumb and wrist movements.

How is DT diagnosed?

The Finkelstein test requires the patient to place the thumb in palmar flexion while the examiner does ulnar deviation of the wrist. Sharp pain along the radial wrist at the first dorsal compartment is indicative of a positive test. 

The Eickhoff test involves asking the patient to clench the thumb with the other fingers while deviating the wrist towards ulna, which elicits sharp shooting pain over the radial aspect of the wrist if positive. (https://www.ncbi.nlm.nih.gov/books/NBK442005/) 

The diagnosis of DT is a clinical one based on typical history and examination findings. Plain radiographs may rule out fractures of scaphoid, radial styloid and osteoarthritis of carpometacarpal joints. Ultrasound of the wrist helps in the identification of the septum in the first dorsal compartment, the elucidation of which helps increase the success rate of corticosteroid injection. 

What are the treatments for DT?

• Icing the wrist helps reduce pain and swelling. Applying ice 3-4 times/day for 20 minutes is recommended.
• Immobilization in a removable semi-rigid splint will help provide pain relief. 
• Over the counter NSAIDs helps reduce inflammation and pain, however if the symptoms persist for more than 10 days the patient shoulder seek medical advice. 
• Corticosteroid injection has been reported to provide near complete pain relief with one or two injections in 52% to 90% patients. (https://my.clevelandclinic.org/health/diseases/10915-de-quervains-tendinosis) 

If symptoms fail to improve or recur after two injections, operative management is an option. It is usually an outpatient procedure where the surgeon makes a tiny incision in the tendon sheaths to make more space for movements. (https://www.ncbi.nlm.nih.gov/books/NBK442005/) 

Adequate rest, avoiding repetitive movements and using ergonomics for heavy weight lifting tasks will minimize the strain on wrist tendons. 

What are the physical therapy treatments for DT? 

There is lack of high-quality evidence about the effectiveness of Laser therapy, therapeutic ultrasound and acupuncture as treatment modalities.

Exercises that have known to help improve strength and flexibility in thumb and wrist include:

• Gentle sponge ball squeeze 3-4 times/day with 5-10 reps each time. 
• Progress the same exercise by adding 2-5 second of squeeze hold if not painful.
• Thumb movements in all directions on a table top 
• Wrist movements in all directions