De Quervain’s Tenosynovitis

The Case of the Painful Thumb
What is it?

Pain at the base of the thumb or on the thumb side of the wrist is not only annoying but can greatly impact your ability to participate in daily activities. While there can be many causes for this pain, one of the more common causes is called De Quervain’s Tenosynovitis.

This condition involves two tendons that control the movement of the thumb, the extensor pollicis brevis (EPB) and the abductor pollicis longus (APL). The EBP and APL run together in a tunnel called the synovial sheath. When the tunnel or sheath becomes inflamed this causes pain especially with movement of the thumb or wrist. Movements such as pinching, twisting, or lifting are often very painful.

Causes

This inflammation is commonly caused by overuse of the thumb and wrist. Activities such as lifting a child in and out of a car seat, holding a newborn baby, or being pregnant have helped this condition earn the term Mother’s Wrist or Mommy’s Thumb. You do not need to be a mother to suffer from De Quervains, other common causes include gardening, cooking, computer use, writing, or any other repetitive wrist or thumb motions.

Treatment

Because this is an overuse injury, treatment should always include activity modification. This may be adjusting the time spent doing an activity, changing the position your wrist or thumb are in while using them, or modifying your workspace. Activity modification, along with the use of brace (over the counter or custom) will help to give the tendons the rest they need.

A physical or occupational therapist can be very helpful in assisting in the recovery process. Therapy will focus on techniques to help decrease inflammation, stretching the tendons, and guidance in modifying your activities. Your therapist will make sure to learn about the cause of your pain to better help structure your treatment to fit you and ensure that you are able to modify your activities appropriately. Your hand therapist may also suggest making a custom splint called a thumb spica. All of these combined can help set you on your road to recovery.

Other treatment may include a cortisone injection in the area to help decrease inflammation. This is done by a physician, and can often be useful in conjunction with therapy.

De Quervain’s is just one condition that may cause pain in the thumb and wrist. Arthritis and ligament sprains also have similar symptoms. If you have pain in the thumb or wrist, give us a call to have a consult with one of our certified hand therapists and start your path to wellness!

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