Tag Archives: hand pain treatment

De Quervains Disease, Hand Pain, Hand Pain Treatment, Physiotherapy, Wrist pain

DeQuervain’s: How to Manage Thumb and Wrist Pain

If you’ve ever felt a sharp, catching pain at the base of your thumb or along the side of your wrist when gripping your water bottle, holding a newborn, or lifting weights, you might be dealing with De Quervain’s Tenosynovitis, or some call it DQ for short.

This wrist condition is exceptionally common among athletes, manual laborers, new parents, and anyone who uses their hands repetitively. Let’s look at what’s happening inside your wrist, how to test for it, and how physical therapy can help you get back to normal.

What is DeQuervain’s?

Diagram showing DQ, highlighting the inflammation fo the tendon and tendon sheath

A quick anatomy lesson first. De Quervain’s is the inflammation of the tendons and the sheath they run through across the back of your thumb. Repetitive movements or even a consequence of an acute injury can cause the thickening and narrowing of the tunnel. Then, the tendons that normally slide back and forth in there have a higher chance of getting stuck, further worsening the inflammation.

The 2 muscles specifically that get stuck are called abductor pollicis longus (APL), and extensor pollicis brevis (EPB). Importantly, these 2 muscles give you the ability to move your straighten and move your thumb away from the palm and other fingers.

How do I know if I have DeQuervain’s?

Common signs and symptoms include:

  • Dull or sharp pain at the back of the thumb, close to the wrist
  • Pain worsens during gripping, lifting, twisting, pinching etc.
  • Pain may radiate up the forearm
  • Catching or snapping sensation when moving the thumb
  • Swelling over the thumb area

Seeing a professional is the best way to diagnose wrist and thumb pain. There are several other causes of wrist and thumb pain and an expert Physiotherapist will be able to differentiate them. They will also determine whether imaging or medical intervention is necessary. For most cases of DQ, conservative treatment with physiotherapy has good outcomes.

How is this condition treated with Physiotherapy?

Physiotherapy is the first line of defense for DQ. Complete rest is never the answer, it will take a combined program of careful strengthening and activity modification to build an environment the tendon can recover in. Here are a couple of the topics and treatments that are likely to be part of your program.

  1. Splinting/bracing: Depending on which hand is affected, it can be very hard to avoid overusing it. A specialized brace called a thumb spica splint is very helpful to combat overuse. It immobilizes the thumb while leaving the other fingers free, giving the tendon a chance to rest. Depending on your individual factors, your PT may have you using it periodically during the day, only while sleeping, or a combo of both.
  2. Exercises: While small muscles, strengthening is a crucial part of any recovery program. Tendons do best when they are loaded, they need that stimulation to get stronger and more resilient. Your PT will you determine the right stage of exercises to begin with depending on your severity. They may also teach you tendon gliding exercises to prevent adhesions and scar tissue formation, improving the mobility of the tendons.
  3. Activity modifications: Your PT will help you determine aggravating activities in your daily life. Whether it’s changing your mouse and keyboard setup, a different grip in the gym, or a new way to hold your infant, there are strategies to minimize the strain of overuse.
  4. Manual therapy: Massage, soft tissue, and joint techniques may all be used to help pain relief, relieve scar tissue restrictions, and bring blood flow into the affected area. The specific techniques will be chosen based on the individual impairments seen in your assessment.

Can DeQuervain’s be avoided?

Consider doing stretches like above if you have a repetitive job every 30 minutes to give yourself a break.

There are many tips and advice that can be followed to minimize the risk of developing an overuse injury like this.

  1. Lift with good form. The wrists should always be in neutral, not bent to the side or back. If you have a hard time with this, consider lightening the load or using wrist wraps to help.
  2. Take frequent breaks. If you have a repetitive job or a hobby, the tension builds up over time. Even if it’s as simple as keyboard and mouse work, frequent breaks every 30 minutes for 30s-1min can make a big difference.
  3. Use other muscles. Our hand and wrist muscles are relatively small compared to other areas. If possible, use different techniques that minimize gripping or pinching with your thumbs and fingers. For example, as physios we frequently use other body parts like our elbows or knuckles to apply pressure to save the strain on our hands.
  4. Identify early signs. If you already feel a nagging pain or ache, waiting and hoping for it to go away is not a winning strategy. The earlier you catch and take care of it, the easier it is to recover. Going to Physio early on can make the difference between a few weeks of recovery and minimal disability, or a few months of recovery and having to modify a lot of things in your life.

Looking for help with wrist or thumb pain?

Look for PhysioNow! We have expert Physiotherapist help across 10 West GTA locations. Come find us in Burlington, Oakville, Mississauga or Etobicoke! Don’t let your pain stop you from participating in your life, get started with recovery today. Book with PhysioNow for your first assessment and treatment.

Hand Pain, Hand Pain Treatment

DeQuervain’s Tenosynovitis: Why does my thumb hurt?

Leave a comment

What is DeQuervain’s Tenosynovitis?

Diagram showing the 2 inflamed tendons (extensor pollicis brevis and extensor pollicis longus)

DeQuervain’s tenosynovitis is inflammation involving 2 of the tendons in the thumb and along the side of the wrist. The names of these 2 muscles are the extensor pollicis brevis and the extensor pollicis longus, as depicted above. First, to break down the naming, the Latin name of the thumb is pollex, hence pollicis, while the “extensor” refers to the movement that the muscles create at the thumb, extension! Lastly, brevis and longus refers to how short (or brief!) or long the muscle is with brevis being the shorter and longus the longer. In tenosynovitis, these 2 muscles thicken and swell above their normal side. As a result, the tendons don’t slide as easily and normal mobility of the hand, wrist and thumb become painful.

Who gets DeQuervain’s Tenosynovitis?

Usually, this is a repetitive sprain injury so individuals that use their hand and wrists a lot in their daily life or workplace are more susceptible to developing DeQuervain’s. Oftentimes, it is developed in middle aged individuals around 30-50 years old. For example:

  • Women during or after a pregnancy
  • Parents with small children or baby care
  • Job or hobbies that include repetitive grasping or holding

What are the signs and symptoms?

Symptoms will vary based on the severity of the injury and may feel different for each individual. Most commonly, people with DeQuervain’s report:

  • Pain at the wrist and thumb
  • Swelling at the thumb and over the wrist
  • Locking, catching, or sticky sensation when moving the thumb
  • Difficulty and pain with thumb and wrist movements, especially twisting, grabbing, and lifting
  • If more severe, pain may go up the forearm as well

How is it diagnosed?

A health care professional should examine your hand to determine whether there is DeQuervain’s. First, they will look at your thumb and wrist on the affected side and check for pain, swelling, and impairments in your mobility. Next, a specific test, named the Finkelstein’s test may be used to check for the possibility of DeQuervain’s. Your health care professional will put your thumb into your palm and have you make a fist around it, then bend your wrist towards the pinky side of your hand. Then, a test is considered positive if it recreates your pain at the thumb/wrist and indicates that you may have DeQuervain’s. Additionally, medical imaging like an Ultrasound can show DeQuervain’s.

How is DeQuervain’s Tenosynovitis treated?

Physiotherapy Treatment is an effective way to manage and resolve your thumb pain. In the early stages, DeQuervain’s management involves relative rest, bracing or splinting, in order to let the tendon heal and inflammation resolve. A lot of this will involve proper education on when to wear the brace, activities you should avoid or modify, and how to manage your symptoms effectively.

Once you attend Physiotherapy, they may use treatments such as

  • Manual therapy and massage techniques to help with pain and stiffness
  • Laser and Ultrasound to help with pain and inflammation
  • Electrotherapy for pain relief
  • Custom exercise programs to improve your mobility, strength, and prevent a reoccurring issue
  • Grip retraining
An example of a thumb mobility exercise called thumb opposition

Most cases of DeQuervain’s resolve conservatively with Physiotherapy Treatment. Unfortunately, in some cases, the pain becomes chronic and a referral to surgery may be indicated. Next, in this surgery, the tendon sheath is cut to make more room for the irritated tendons, which effectively resolves the symptoms. Additionally, recovery from this surgery is fairly simple and few encounter post-surgical complications.

Where can I find treatment?

If you are experiencing DeQuervain’s or any other kind of hand pain, look for PhysioNow! We are a Physiotherapist owned and operated clinic with locations across the GTA. Specifically from Burlington, Oakville, Mississauga, and Etobicoke we have 10 locations to offer our patient’s convenience. Book with us today for your first assessment and treatment with a Physiotherapist!