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De Quervain's Tenosynovitis
Physiotherapy & Hand Therapy



De Quervain's tenosynovitis is also commonly known as

  • washerwoman's sprain
  • mummy thumb
  • de Quervain's tendinosis of the sheath
  • blackberry thumb
  • radial styloid tenosynovitis and
  • de Quervain's disease

It is basically a tendinosis of the tendon sheath (cover) that wraps around the two tendons of the thumb, the extensor pollicis longus (EPL) and the abductor pollicis brevis (APB).

How does de Quervain's tenosynovitis happen?

So the two tendons as mentioned above, the EPL and APB tendons run alongside each other, and have closely and related functions:

  • which is to move the thumb away from the hand by extension (like how you signal "good" with your thumb) and/or
  • abduction (make a "C" or an "O" of your thumb and fingers).

What happens is that these tendons run through a synovial sheath (imagine it to be like a blanket that wraps around the tendons) which contains them. Due to repetitive motion, this synovial sheath slowly over time and damage, thickens and degenerates, causing inflammation, swelling and pain).

De Quervain tenosynovitis is also commonly seen in new mothers and fathers, as they often lift up and put down their newborn babies by holding the babies under their armpits BUT studies show that De Quervains is more common in women as their wrists have a greater angle at the greater styloid process, causing a higher level of stress for the APB and EPL at the synovial sheath.

Causes of de Quervain's tenosynovitis

It is related directly to:

  • wear and tear
  • repetitive strain injury
  • one's responsibilities, roles and work.

As mentioned earlier, new parents often carry and put down their new borns, causing additional strain and stress repeatedly at their wrists (and their backs).

People whose work involves a flicking of their wrists e.g. opening a can or bottle; or similarly, individuals whose work involves using a lot of screw driver will also have this injury as well.

Also, there is an association caused by the use of smartphones, which was where the term "Blackberry Thumbs" came about.

Which is basically de Quervain's tenosynovitis.

Symptoms and Testing

Arrow marks were the pain is worsened in DeQuervain syndrome

Main symptoms of De Quervain's tenosynovitis are

  • sharp pain with thumb and wrist flexion
  • tenderness at APB/EPL at wrist crease
  • swelling
  • difficulty using thumb in activities that involve gripping/gripping+movements

In our physiotherapy and hand clinics in Singapore, first of all we need to use the Finkelstein test to diagnose this disease.

To perform this test, we get our patients to bend their affected thumbs  into the palm of their hands, close the other four fingers around the thumb, and bend their wrist downwards (see image above withthe arrow).

At any point if there is pain, there is an increased likelihood of de Quervain's - the more painful with lesser movements, the more severe.

Next we need to test for tenderness and swelling at the synovial sheath at the wrist for the EPL and APB.

Tenderness and swelling usually confirms the the De Quervain's tenosynovitis diagnosis, and it also pinpoints more acute or serious the condition is (there are mild forms and there are severe forms, where movements are locked/too painful to move).

We may also need to do differential diagnosis to rule out possible conditions such as

...so that we give accurate and effective hand physiotherapy treatment for their exact hand conditions.

Physiotherapy and Hand Therapy Intervention

Surgeons and physicians will usually four types of medical/surgical solutions, based on severity and how fast patient want results:

  1. painkillers and anti-inflammatories
  2. H&L injections
  3. surgical "release" intervention
  4. non-invasive hand therapy, occupational therapy and physiotherapy for De Quervain's

For most cases of de Quervain's tenosynovitis, we will often custom make a splint to fit your hand and wrist, to immobilize the wrist and thumb at the meta-carpo-phalangeal joint (MCP level; at the thumb's knuckle) but at the same time allows your thumb end joint and other fingers to move - this is important to rest the hand and protecting it from aggravation due to

  • accidental mobilization
  • accidentally lifting something
  • trauma such as direct hits, blows etc.

We also will provide cold therapy to decrease the amount of inflammation and swelling, decreasing the amount of pain that you may experience (pain relief). We'll combine this with retrograde massage for a synergistic pattern to drain swelling.

Ultrasound therapy will also help to accelerate the healing process of the soft tissues such as synovial sheath and tendons.

The hand therapist would then also need to determine the cause of the injury, so that we will be able to advise on any changes required to activities/exercise e.g. changing the way a task is done if the inappropriate biomechanics was used e.g. ergonomics of keyboard, usage of phone, writing etc



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Phoenix Rehab Group works with specialist physiotherapists and rehab therapists who are highly trained, qualified, experienced and passionate to provide high level of expert care to our patients.



HAND THERAPY & CUSTOMIZED SPLINTING

Patients who sustained injuries to their elbows, forearms, hands, wrists (sprains and fractures) and fingers, usually will benefit / require Hand Therapy to

  1. manage and decrease hand pains
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  3. increase the function of their hand following injuries or post-operations

Commonly treated hand pain injuries includes



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Clinical Pilates is a form of physical exercise that focuses on posture, core stability, balance, control, strength, flexibility and breathing.

It is a system of safe and effective exercises, which meet specific individual needs, to treat a wide range of injuries and conditions.

You may do Pilates as matwork or with the reformer or both, and every session will be customized 100% to your fitness, injury and tolerance.



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Sports and deep tissue release massage helps to increase nutrient-rich blood flow to tired, tight and tense muscles to accelerate recovery and  shorten downtime / recovery period required.

It also prevents muscles from scar tissue micro-tears (and potential ruptures), and increases muscle performance. Having regular deep tissue and sports massage will keep your muscles healthy and fit with body/movement-confidence.

Read the benefits of regular deep tissue release therapy here.



ALTERNATIVE THERAPIES

All our allied health therapists and TCM physicians are fully insured and registered with Allied Health Professions Council (AHPC) and Traditional Chinese Medicine Board (TCMB).

See our entire team here with introductions and their specializations.

At the first session, our specialist physiotherapists will carry out a thorough assessment, helping them to select the most appropriate treatment to help you recover as well as provide treatment in the same session.

Follow up sessions are inline to provide expert treatment for your pain as well as prescribing specific exercises to reduce your risk of re-injury and giving you a long term solution.

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