De Quervain Syndrome
Scientific explanation of De Quervain’s syndrome:
This condition involves two tendons:
– The tendon of the long abductor digitorum muscle. [Abductor Pollicis Longus]
– The tendon of the short extensor digitorum muscle. [Extensor Pollicis Brevis]
Around these tendons is a covering called the tendon sheath, then comes the Extensor retinaculum covering, that surrounds the posterior tendons that pass through the wrist and holds them in place, and the tendons of the thumb that were explained pass under this covering.
In the case of De Quervain’s, swelling occurs in the tendons or the covering surrounding the mentioned tendons, which leads to difficulty in the movement of the tendons through the small tunnel through which they pass, and this results in pain in the thumb joint.
Causes:
1. Direct trauma to wrist & thumb.2. Rheumatoid Arthritis.3. Hormonal changes during pregnancy.4. Another important reason is, repetitive motion of the wrist & thumb which is usually seen in: Sports that include repetitive motion of wrist & thumb (e.g racket sports)5. Childcare workers / Parents (repetitive lifting motion of children leads to thumb's pain.6. Labour workers.7. Hobbies with repetitive motion of wrist & thumb. The over-use of wrist & thumb causes this pain, also seen in gardeners.
Symptoms:
1. Pain & swelling at the base of the thumb.2. Difficulties in moving the thumb & wrist especially in grasping & pinching activities.3. Stiffness in the thumb. It feels less smooth (catching sensation).4. Pain radiates from wrist & thumb to forearm.
Treatment:
We start with Pain management using:
Splint
(reduce movement thus reducing pain).
Hot/cold pack
depending on the patient. I often use cold pack in the first stage of treatment for sever pain to reduce pain & inflammation.
Laser therapy can also be used to reduce pain.
After reducing the pain, we move on to the other stages of the treatment plan:
Range of motion & stretching exercises
(within pain limit)
If the patient managed to do range of motion and stretching exercises without pain, Start strengthening exercises
(It should be gradual within pain limit).
Activity modification:
Lastly and most important part of the treatment plan, Activity modification: (which activity caused this pain). E.g: sports, childcare, work. We teach the patient how to perform their daily activities with proper biomechanics/form . Pain will re-occur if you did not modify your activities.
