Understanding De Quervain’s Tenosynovitis: A Painful Wrist-Hand Condition
As an Occupational Therapist and Certified Hand Therapist (CHT), I often see individuals limited by sharp wrist and/or thumb pain that just won’t go away. One common culprit? De Quervain’s Tenosynovitis, a condition that can significantly impact daily life if left untreated.
Regarding pain triggers for De Quervain’s, I always say: “It’s the little things, not the big things.”
What do I mean? People who have De Quervain’s can often lift and carry even heavy things without pain when holding the wrists still, but forget trying to open that zip top package, hold a pen, or shake hands at a work event. And fastening all of those snaps on your baby’s adorable outfit–Ouch! The pain can feel sharp.
What is De Quervain’s Tenosynovitis?
This is a repetitive strain injury that affects the tendons on the thumb side of the wrist. These tendons, named the abductor pollicis longus (APL) and extensor pollicis brevis (EPB,) are responsible for thumb movement and pass through a narrow sheath on the thumb side of the wrist. When irritated by overuse, these tendons become inflamed, causing acute pain, swelling, and restricted movement.
Common Signs and Symptoms
You might be experiencing De Quervain’s if you notice:
- Pain or tenderness at the base of the thumb and side of the wrist
- Burning sensations on the thumb side of the wrist
- Discomfort with grasping, pinching, or twisting/turning
- Pain that worsens with repetitive movements like lifting a baby, texting, or washing dishes
- Swelling over the tendon sheath
- Difficulty moving the thumb or wrist
One simple clinical tool that helps determine whether the APL and EPB tendons are irritated is called the Finkelstein test. Warning: this can be quite painful, so you may prefer to read about it, rather than actually perform the maneuver.
Finklestein’s is performed by making a fist with your thumb tucked underneath the fingers and then gently tilting your hand toward your pinky. If this causes sharp pain at the base of the thumb and thumb side of the wrist, it may be due to De Quervain’s.
Who’s at Risk?
De Quervain’s tends to affect:
- New parents from repetitive lifting, pinching and twisting tasks of childcare and/or the effects of hormones on joint and soft tissue mobility associated with pregnancy and post-partum
- Breast cancer survivors taking aromatase inhibitors
- Smartphone users and gamers
- Workers who type or mouse frequently
- Individuals who engage in repetitive gripping or lifting
- People with underlying inflammatory conditions
How Occupational Therapy Can Help
Treatment doesn’t always require medication or surgery. An orthopedic doctor may offer a steroid injection to calm the pain, but Occupational Therapists who are Certified Hand Therapists (CHT) offer conservative, effective solutions to reduce pain and restore function. Even if you have opted for a steroid injection, your CHT comes in “handy” for teaching techniques to stop the problem from returning after the medication wears off.
Orthosis (Splint) recommendations
A thumb spica or what’s properly called a “long opponens orthosis” supports the thumb and wrist, reducing strain on the tendons and allowing inflammation to settle. It is important to have a device that fits properly and does not cause pain.
Orthotics that only immobilize the wrist and leave the thumb free can make the problem worse. CHTs can recommend supports that work for you and can fabricate a custom orthosis to ensure a good fit. The orthosis may be used in conjunction with elastic taping.
Activity Modification
Identifying and adapting daily tasks that trigger symptoms such as grasping techniques, keyboard positioning, work outs or parenting routines to prevent further irritation.
Occupational therapists teach strategies to avoid ongoing stress and strain, such as teaching “neutral wrist” mechanics and or suggesting adaptive equipment for or modified methods of task performance.
Manual Therapy
Targeted soft tissue mobilization, myofascial release, and gentle joint mobilizations help improve circulation, reduce adhesions, and restore mobility in the soft tissues. In some cases, cupping or dry needling may be an option for pain reduction.
Therapeutic Exercise
Once inflammation subsides, we introduce gentle exercises to improve tendon gliding, restore strength, and prevent re-injury. It is especially important to ensure that the muscles around the upper back and shoulder girdle are well-balanced to prevent too much work in the hand and wrist.
Believe it or not, upper body alignment can play a role in wrist/hand pain. This is especially true if you perform a lot of forward-facing tasks such as seated computer work, forward bending, reaching and/or carrying. And don’t get me started on the challenges of carrying a baby in a heavy car seat because the folks who engineered the car seats did NOT consult with an occupational therapist.
Ergonomic and Wellness Education
From joint protection strategies to self-care routines, education is key. Small changes in how you use your hands can make a big difference in long-term recovery. CHTs can personalize education to allow you to make habit changes for health.
When to Seek Help
If thumb or wrist pain is limiting your ability to work, care for your family, or enjoy hobbies, don’t ignore it. Early treatment leads to quicker recovery and prevents chronic problems.
As a Certified Hand Therapist in Evanston, IL, my goal is to help you regain comfort, strength, and function. This will enable you can get back to what matters most, pain-free. If you need Hand Therapy in the Chicago area or the North Shore, click the link below for my website to make an inquiry.
Relieve the pain, restore the motion and shake that hand.
Flourish Recovery & Wellness 