Meet today’s guest blogger:
Kristy Uddin, OTR/L, Astym Provider
Integrated Rehabilitation Group, Inc.
Locations throughout the greater Puget Sound, Washington area
Pacific Avenue Hand Therapy – (425)374-2846
Snohomish Physical Therapy – (360)568-7774
Two of the main tendons to the thumb pass through a tunnel (or series of pulleys) located on the thumb side of the wrist. Tendons are rope-like structures that attach muscle to bone. Tendons are covered by a slippery thin soft-tissue layer, called synovium. This layer allows the tendons to slide easily through the tunnel. Any swelling of the tendons located near these nerves can put pressure on the nerves. This can cause wrist pain or numbness in the fingers.
How does this condition develop? De Quervain’s tendinitis is caused when tendons on the thumb side of the wrist are swollen or irritated. The irritation causes the lining (synovium) around the tendon to swell, which changes the shape of the compartment. This makes it difficult for the tendons to move as they should. Activities such as opening jars, wringing out washclothes or sponges, cutting with scissors, any activity that involves ulnar deviation and weight on the wrists (lifting a frying pain or heavy objects out of the oven that put resistance on your wrists.
What are the symptoms?
• Pain may be felt over the thumb side of the wrist. This is the main symptom. The pain may appear either gradually or suddenly. Pain is felt in the wrist and can travel up the forearm. The pain is usually worse when the hand and thumb are in use. This is especially true when forcefully grasping objects or twisting the wrist.
• Swelling may be seen over the thumb side of the wrist. This swelling may occur together with a fluid-filled cyst in this region.
• A “catching” or “snapping” sensation may be felt when moving the thumb.
• Pain and swelling may make it difficult to move the thumb and wrist.
• Numbness may be experienced on the back of the thumb and index finger. This is caused as the nerve lying on top of the tendon sheath is irritated.
What tests are done to determine what it is?
The Finkelstein test is conducted by making a fist with the fingers closed over the thumb and the wrist is bent toward the little finger. The Finkelstein test can be quite painful for the person with De Quervain’s tendinitis.
Tenderness directly over the tendons on the thumb side of the wrist is a common finding with this test.
How can you make the pain go away? (Conservative care & surgery)
• Conservatively – Splints. Splints may be used to rest the thumb and wrist
• Astym treatment
• Anti-inflammatory medication (NSAIDs). These medications can be taken by mouth or injected into that tendon compartment. They may help reduce the swelling and relieve the pain.
• Avoiding activities that cause pain and swelling. This may allow the symptoms to go away on their own.
• Corticosteroids. Injection of corticosteroids into the tendon sheath may help reduce swelling and pain.
If you elect surgery what is the goal?
Surgery may be recommended if symptoms are severe or do not improve. The goal of surgery is to open the compartment (covering) to make more room for the irritated tendons.