De Quervain’s Tenosynovitis is a painful inflammatory condition affecting the sheath around the tendons of the thumb. These tendons run between the wrist and the thumb. Chronic overuse is the most common cause. For example, repetitive hand or wrist movement while typing or gardening. Other causes include scar tissue formation from direct injury to the wrist or rheumatoid arthritis. Frequent movement of the thumb on the screen of your smartphone is also one of the causes of DeQuervain’s Tenosynovitis, that’s why it is also called TEXTING THUMB.
Pain and swelling are felt near the base of your thumb and the same side of the wrist. Pain may travel along the backside of the thumb. As the tendons involved are responsible for movements of the thumb, the thumb movements become painful. There is difficulty with tasks involving grasping, pinching, wringing, and making a fist. Also, the grip strength is reduced. It is seen frequently in middle-aged women.
Risk factors of De Quervain’s Tenosynovitis are post-pregnancy, frequently lifting weight, or carrying a baby with the thumb away from the wrist and in professionals like pianist, guitarist, carpenters, and golfers.
- REST is essential for the healing of inflamed tendons. So, a Thumb spica splint is given to rest the thumb and the wrist for 2-3 weeks. Avoid any pain aggravating movements. Massage ice to the affected area to control inflammation. The affected area can be iced for 10 -15 minutes, twice a day. Once the pain subsides, one can start with the following exercises to strengthen the tendons of the thumb and wrist muscles.
- EXERCISES FOR DE QUERVAIN’S TENOSYNOVITIS
- Place your affected hand with the palm down on a table. Now lift the affected thumb gently away from the table i.e, upward and sideways in a diagonal plane. Then slowly bring your thumb back to the table in line with your fingers. Do ten repetitions.
- Place your affected hand sideways such that the little finger is touching the table. Now, move the affected thumb away from the rest of the fingers. Then slowly bring your thumb back in line with your fingers. Do ten repetitions.
- Place your hand on a table with the palm facing up. Lift your thumb away from the palm so that it is pointing upwards. Hold for 5 seconds and repeat ten times.
- Put an elastic band around your fingers and thumb. Then gently move your thumb against the resistance of the band. Do ten repetitions.
- Place an elastic band around the thumb and index finger with the tip of the thumb bent. Lift your thumb up and away from the index finger. Repeat ten times.
- Thumb Stretch -This stretch is done by moving your thumb in and out of the palm. Start with your thumb pointing outward, away from your palm. Then move your thumb across your palm to try to touch the base of your little finger and then the tip of the little finger. Hold for five seconds and repeat five times.
- Grip Strength exercise with ball- Hold a softball in your hand. Squeeze it tightly for ten seconds, and then release. Repeat ten times.
- Wrist ROM Exercises-Starting position is – your elbow and forearm resting on a table and hand hanging with the palm facing down. Hold a half kg weight in hand. Now gently bend your wrist forward (fist pointing to the floor), backward(fist pointing to the ceiling), and lastly towards the side of the thumb from neutral wrist position. Hold each position for five seconds and repeat ten times.
3. DEEP TISSUE MASSAGE -This is to be done by your physiotherapist. Transverse friction massage with medium pressure in the anatomical snuffbox and the massage along the length of tendons while the wrist goes from radial to ulnar deviation and thumb from extension to flexion helps with any adhesions and scar tissue. Thus aids in pain relief.
Most of the cases of DeQuervain’s tenosynovitis respond well to conservative treatment. Few patients might need steroid injection or surgery.
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