Written by:
Grace Boxleitner, OTR/L
VHSF Fellow '22/'23
De Quervain’s tenosynovitis is a common condition within the hand therapy setting with peak prevalence among individuals age 40-50 years old. This condition is marked by thickening a degeneration of the tendon sheaths around the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) as the tendons pass through the fibro-osseous tunnel of the first dorsal compartment. This condition manifests predominantly amongst women in late pregnancy or post-partum due to repetitive lifting with improper body mechanics. This post aims to explore the anatomy of De Quervain’s tenosynovitis, its impact on function, and treatment guidelines from a hand therapist’s perspective.
Anatomical Overview and Presentation
De Quervain’s tenosynovitis is an inflammatory condition within the tendon sheaths of APL and EPB as they pass through the fibro-osseous tunnel at the wrist. This condition primarily affects individuals engaging in repetitive activities of the thumb and wrist leading to pain, swelling, and functional impairments. Notably, mothers and those caring for young children are at heightened risk for injury due to the repetitive nature of lifting and holding infants.
Patients often present with radial-sided wrist pain which is exacerbated by thumb MCP flexion and ulnar deviation of the wrist. Pain may be sharp in nature during resisted wrist motion followed by aching discomfort. Functionally, many patients complain of difficulty opening jar lids. Patients will be tender to palpation over the first dorsal compartment of the wrist. Provocative testing is performed through performance of Finkelstein’s test. During this maneuver, a patient is asked to place the thumb in palmar flexion while ulnarly deviating wrist. A positive test is indicated by sharp pain along radial aspect of the wrist.
Interventions and Treatment Considerations
Initial management of De Quervain’s tenosynovitis is focused on inflammation management and pain relief.
Splinting is an important component of early-stage intervention to avoid continued aggravation of first dorsal compartment. A radial based forearm thumb spica may be considered during aggravating activities. Additionally, its use during night-time may be indicated for individuals who sleep with deviated posture of wrist as this continues to place load across involved tendons. Splint may be prefabricated, or custom made placing the wrist in 15 degrees extension, thumb midway between palmar and radial abduction, MP joint in 10 degrees of flexion and IP joint free (Cannon, 2020). Splint should be removed several times per day for pain-free range of motion of wrist and thumb as strict immobilization in a thumb spica may limit progression as it increases myxoid degeneration of the involved tendons (Larson, 2021).
Education surrounding activity modification is an integral part of treatment. Mothers and caregivers should be instructed to avoid lifting with deviated wrists.
As De Quervain’s tenosynovitis is an inflammatory condition, strengthening should be avoided until pain has resolved. After regaining full pain-free motion to thumb and wrist, resistance tasks may be added to plan of care. Incorporating resistance training towards the end of rehabilitation will help strengthen involved tendons and reduce risk of future injury.
In cases where conservative management does not yield improvement, corticosteroid injections may be considered to reduce inflammation of the tendons within the first dorsal compartment. Infrequently, release of first dorsal compartment may be required if repeated steroid injections and bracing are unsuccessful.
Conclusion
De Quervain’s tenosynovitis requires a comprehensive treatment approach particularly for high-risk populations such as mothers with young children. By combining acute symptom management with longer-term therapeutic interventions and lifestyle modifications, hand therapists can significantly improve patient outcomes. Education on preventative measures and ergonomic adjustments is crucial to reducing the risk of recurrence and ensuring the successful return to activities of daily living. Through personalized care and utilization of evidence-based practices, hand therapists play a vital role in guiding patients through recovery and beyond, ensuring both symptomatic relief and functional restoration.
Cannon, N. M. (2020). Diagnosis and treatment manual for physicians & therapists: Upper extremity treatment guidelines (5th ed.). Hand Rehabilitation Center of Indiana.
Larsen CG, Fitzgerald MJ, Nellans KW, Lane LB. Management of de Quervain Tenosynovitis: A Critical Analysis Review. JBJS Rev. 2021 Sep 10;9(9)