One of the most common causes of wrist and thumb pain is a condition called DeQuervain’s Tenosynovitis. De Quervains Tenosynovitis / Teninopathy is a relatively common overuse condition affecting two of the tendons of the thumb – the Extensor Pollicus Brevis (EPB) and Abductor Pollicus Longus (APL). The APL and EPB tendons travel side by side along the inside edge of the wrist. They pass through a synovial tunnel near the thumb side of your wrist. The tunnel helps hold the tendons in place.This tunnel is lined with a slippery coating called tenosynovium, which allows the two tendons to glide easily back and forth as they move the thumb. In DeQuervain’s, inflammation of the tendon and tenosynovium constricts the movement of the tendons within the tunnel.
The symptoms associated with this condition usually develop gradually. Initially, symptoms may present as an ache or stiffness in the back of the wrist and thumb following an aggravating, repetitive or unaccustomed activity. This may often be felt at night or first thing in the morning and may warm up with heat and movement in the early stages. As the condition progresses, pain may be felt with every day activities involving the wrist and thumb.
Occasionally, pins and needles or numbness in the thumb may be experienced along with weakness in the wrist, hand and thumb. This may present as difficulty performing fine movements of the hand, reduced grip strength, or an increased frequency of dropping objects. De Quervains tenosynovitis may also be associated with neck or upper back pain on the same side.
Causes
- When forces are excessive, due to too much repetition or high force, damage to the tendons may occur.
- Repeated hand and thumb motions such as grasping, pinching, squeezing, or wringing may lead to the inflammation of tenosynovitis.
- Holding your hand at an angle to your wrist creates a compression point that excessively rubs the tendon.
- This inflammation can lead to swelling, which restricts the smooth gliding action of the ten dons within the tunnel.
- Scar tissue from a previous injury can make it difficult for the tendons to slide easily through the tunnel.
- Arthritic diseases that affect the whole body, such as rheumatoid arthritis, can also cause tenosynovitis in the thumb.
DeQuervain’s is also more common in expectant and new mothers.
Treatment
Physiotherapy treatment for De Quervains is vital to hasten the healing process, ensure an optimal outcome and decrease the likelihood of future recurrence. Treatment may comprise:
- Soft tissue massage
- Low level light laser therapy (LLLT)
- Thumb bracing or splinting
- Thumb taping
- Joint mobilisation
- Dry needling
- Ice
- Exercises to improve flexibility and strength
- Education
- Training and activity modification advice
- Technique correction
- Anti-inflammatory advice
- Devising an appropriate return to activity plan