De Quervains’s Syndrome
De Quervains syndrome is a painful condition that affects the tendons around the bottom of the thumb. The condition is swelling and irritation of the tendons and its surrounding sheath. These symptoms tend to be provoked with gripping or rotation of the fist and hand. The two main tendons to the thumb pass through a tunnel like complex located on the thumb side of the wrist. The tenon is surrounded by a sheath that protect the tendon between this is a thin tissue layer known as synovium. Synovium is responsible for aiding the smooth fluid motion of the tendons during thumb movements. Any swelling or irritation in this area causes increased friction which means symptoms will develop.
Here are some of the most common signs of De Quervains:
Pain over the thumb side of the wrist
- This is the primary complains for this injury. Pain will become worse with hand and wrist movements in particularly griping and twisting the wrist. Pain can also start suddenly or gradually and occasionally travel up the forearm
Swelling over the area
- Swelling may be prevent on the thumb side of the wrist occasionally associated with a fluid filled prominence.
A clicking/catching sensation
- This may be felt over the swollen area when moving the thumb.
Reduced range of motion
- The pain and swelling present may make is difficult to move the thumb and wrist
The main goal with this injury its to reduce the pain felt as a result of irritation and swelling to the tendon and its surrounding structures. This can be done in two ways either surgical approach or non-surgical (conservative management).
Non-surgical approach: A non-surgical approach can be just as effective as a surgical approach if followed correctly.
- Relative rest – avoiding activities that may provoke your symptoms. This will allow the healing process to begin properly.
- Anti-inflammatory Drugs (NSAIDs) – on steroidal anti-inflammatory drugs can be taken orally or injected in tot tendon compartment to target the swelling and pain.
- Splints – initially splints can be used to protect from further injury and irritation to the tendon.
- Corticosteroids – injection of steroid in to the tendon sheath to help reducing swelling and pain
If your cases are more severe you r doctor or physiotherapist may suggest that you undergo a small surgery. In the surgery your doctor will examine the sheath surround the involved tendons and will make a small incision causing more space to reduce the irritation placed on the tendons during movement.
Post-surgery your physiotherapist will educate you about the healing process you will be going though and rehabilitation program you will be placed on. Most of which will contain excises to strengthen and re gain any lost range of motion in the wrist and thumb.