De Quervain's SyndromeDe Quervain's Syndrome

Hello and welcome back to the ThreeSpires Physiotherapy blog where we take a look at all things physiotherapy and health related. I thought this time it would be good to move away from problems of the lower limbs and go up to the upper limb and in this case the hand.In this article we will look at an annoying and painful condition called De Quervain's Syndrome that affects the thumb and wrist area. Just to remind any readers: we are a home visit physiotherapy service based in Lichfield and offering services in Sutton Coldfield, Tamworth, Cannock, Rugeley and Walsall.

What is De Quervain's Syndrome?

De Quervain's Syndrome is a thickening and inflammation of the tendons and tendon sheaths that control movement of the thumb and has several other more common names such as Gamer's Thumb, Texter's Thumb and Blackberry Thumb. There are two tendons involved: extensor pollicis brevis and abductor pollicis longus, these two muscles and associated tendons are responsible for moving the thumb away from the hand. Tendons are the tissues that attach muscles to bones and are kind of like cables that transmit the force from the muscles to the bones.

What are the Symptoms of De Quervain's Syndrome?

It usually gives pain over the outside part of the thumb and wrist when pinching or using the thumb (commonly to text) and sometimes the thumb and wrist can become swollen. The pain from De Quervain's Syndrome is usually mostly just there when being used and when rested tends not to give pain.

What Causes De Quervain's Syndrome?

Although the exact causes of De Quervain's Syndrome have not been fully established there is thought to be a link between doing lots of thumb movements (e.g. texting), lots of pinching and twisting and some people suggest that it is a repetitive strain type injury.

Who is Most at Risk of De Quervain's Syndrome?

Although anyone can get De Quervain's Sydnrome it is more common in women and can occur during or after pregnancy. It is also seems to be more prevalent in people who use their hands a lot for work. Certainly it becomes more common as people age and it is important that it is not confused with arthritis in more elderly patients.

How is De Quervain's Syndrome Diagnosed?

De Quervain's Syndrome is usually diagnosed clinically (via questioning and a physical examination) rather than through imaging and other investigations. A common test used to diagnose (or at least give a high degree of likelihood) is Finkelstein's Test. This involves taking hold of the thumb and moving it and the whole hand towards to opposite side of the wrist, pain during this test indicates that it is likely the patient has De Quervain's Syndrome. Although it is also possible that they simply have arthritis of the thumb, so a good examination is necessary to determine which is most likely. Occasionlly it may be necessary to have an x-ray or other imaging of the thumb to rule out arthritis as a cause of the pain.

Treatment for De Quervain's Syndrome

There are a variety of treatment options available for De Quervain's Syndrome and I have tried to outline below a reasonable management plan/ series of treatment options.

1. Assessment & Diagnosis: yes, I understand that this may seem blindingly obvious but it is also extremely important that if you think you may have De Quervain's Syndrome that you get it assessed and get a diagnosis. There are several conditions that can have similar symptoms to De Quervain's Syndrome and it is important to have these ruled out. Also by having a confirmed diagnosis of De Quervain's Syndrome it is possible to then begin getting the right treatment and managing the condition properly. Articles such as this one about De Quervain's Syndrome are helpful but no substitute for an assessment with a physiotherapist or doctor.

2. Rest: the main part of any treatment will usually involve rest initially to allow any inflammation to settle. Again, I udnerstand that some people may be thinking to themselves that this is a pretty poor answer to the problem from a physiotherapist! However, sometimes solutons to problems such as De Quervain's Syndrome reall are very simple and just involve resting. This does not have to mean complete rest but could just involve avoiding the specific activities or actions that irritate the condition for example gripiing or pinching. Patients often only need to moderate their activities with their hand and thumb a bit and get a very quick relief from their symptoms.

3. Ice: Using some cold bags or ice applied over the area can sometimes help reduce pain and inflammation in De Quervain's Syndrome. Many patients will find this helpful at the end of the day or in the evening when their thumb is at its worst.

4. Splinting: Sometimes a splint can help if things are particularly painful. Thjis can either be worn in teh day time as a support or possibly at night to protect the area.To understand which type of splint would be best it is probably best to have an assessment for your De Quervain's Syndrome.

5. Anti-Inflammatories: some patients may find that an anti-inflammatory medications such as ibuprofen can be helpful in reducing the pain associated with De Quervain's Syndrome but it is important that you check with your doctor first.

6. Acupuncture: in some cases of De Quervain's Syndrome patents find that acupuncture can be a good treatment. It is important to remember that the effects of acupuncture can be variable and it does not work for everyone.

7. Steroid Injections: some patients find that their De Quervain's Syndrome does not respond to any of the above strategies and they need to try a steroid injection. This can usually be done by your GP or you may need referral onwards to a hand specialist.

As with most conditions in order to know how best to manage your De Quervain's Syndrome it is probably necessary to have a full assessment and this is where one of our physiotherapists will be able to help. Our physios have a lot of experience of helping atients with De Quervain's Syndrome and will be able to conduct a full and detailed assessment that will enable you to understand how best to manage and alleviate your De Quervain's Syndrome. 

Okay, I hope that you have enjoyed reading this article about De Quervain's Syndrome and now have a better idea of how to manage it. If you or anyone you know would like more information then please get in touch.

For anyone reading: we are a home visit physiotherapy service, based in Lichfield but serving anywhere within a 20 minute drive including areas such as Sutton Coldfield, Tamworth, Cannock, Burton and Rugeley. We offer a wide range of services including paediatric physiotherapy, post-operative rehabilitation, neurological physiotherapy and neck and back pain relief. If you need further information or would like to book an appointment we can be contacted on 0788 428 1623 or via enquiries@threespiresphysiotherapy.co.uk

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