Today’s Subject: De Quervain’s Tenosynovitis

I seem to be at that age where it feels like almost everyone is having children. As a result I have been seeing a great deal of concern coming from new mums with wrist complaints . This is very common amongst mums with newborn babies. De Quervain’s Tenosynovitis is usually the diagnosis but is widely known as “baby wrist” or “mommy thumb”.

De Quervain’s Tenosynovitis (Disease)

(Images:www.aidmycarpaltunnel.com)

Description:

For Remedial therapist: Inflammation of the synovium of the abductor pollicis longus and extensor pollicis brevis tendons as they pass in their shared synovial sheath across the radial aspect of the wrist.

For Patients: It is caused by an inflammation of the tendons located on the thumb side of the wrist.

Presentation/ Signs and Symptoms:

For Remedial Therapists: Local tenderness and swelling which may extend proximally and distally. Possible weakness in the affected muscles. Possible creptitus especially with ulnar deviation which is also likely to be painful. Active abduction of the thumb joint against resistance is also likely to be painful.

For Patients: Common symptoms manifest as pain and swelling near the base of the thumb or on top of the thumb, tenderness above the wrist upon palpation(touch), issues with carrying a baby or object, a restriction in the thumb or wrist with movement, and a difficulty gripping, squeezing, pinching and moving the wrist from side to side.

Predisposing Factors or Common Causes:

Repetitive motion involving the wrist and hand in sports such as carrying a baby or infant, racquet sports, tenpin bowling, weight training, rowing, musicians, meat workers etc. Also hyperabduction required during golf swing can affect the left thumb of a right handed golfer and vice versa.

Differential Diagnosis: For Remedial Therapists

Scaphoid Fracture, Flexor Carpi Radialis Tendonopathy, Degenerative Arthritis

Finkelstein’s test

Conventional Treatment:                            

For Remedial Therapists: Splinting, (non-)steroidal injections, electrotherapy, rest from injurious activity, ROM, stretching, strengthening.

For Patients: Avoid repetitive movements which aggravate symptoms, rest wrist as soon as symptoms develop, ice as often as possible but avoid “ice burn” as that can lead to other issues.
If you are a new mum, during activities such as lifting or carrying bub avoid placing your thumb and index finger in the “L” shaped position. If breastfeeding be aware of the positioning of the thumb and wrist, use a pillow to help support baby’s head instead of bearing the weight with your hand.
Ibuprofen and anti-inflammatory drugs can be beneficial but can be a contraindication while breastfeeding. It is best to isolated and deal with the cause of the injury instead of just masking the symptoms. Pain is the body’s way of letting you know something is not right. Please refer to your health professional if drugs are the way you wish to proceed.

Massage Treatment and Contra-indications:

For Remedial Therapists: Once swelling has subsided, deep transverse friction on APL and EPB tendons to reduce adhesions (is likely to be uncomfortable). Tension can be reduced in muscle bellies using deep longitudinal and transverse strokes and compression, especially when active contraction is applied.

(Images:www.aidmycarpaltunnel.com)

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s