What is De Quervain Syndrome?
Inflammation of two tendons and their sheath that control movement of the thumb.APL, EPB
*Syndrome means: it’s a group or set of symptoms that occur together.
*Tendon: rope-like structure that attaches muscle to bone, which allows the muscle to pull on and move the bone.
There are 2 main tendons of the thumb that assist in bringing the thumb out away from the index and help in straightening the thumb joints.
The 2 main tendons are:
- The abductor pollicis Longus. APL.” Help in thumb abduction “
- The extensor pollicis brevis. EPB. “ Help in thumb extension “
Origin: ½ dorsum side of radius.
Insertion: proximal phalanx of the thumb.
Function: Thumb extension.
Innervation: posterior interosseous branch of radialis
Origin: dorsum side of the radius and the ulna.
Insertion: base of metacarpal.
Innervation: same to EPB.
*These two tendons arise from the muscles of the forearm, and then run together in a sheath that makes them close to bone, crossing over from the thumb side of the wrist into the hand.
Any swelling or irritation to these two tendons and thickness in the sheath may cause inflammation and tendons no longer fit well inside the sheath.
- Inflammation of tendons at the base of the thumb.
- Causes Pain, tenderness, and swelling at the affected side.
- Common in age between 30-50 years, “Women more than Men”
- Can be diagnosed by the Finkelstein test.
Main Causes of the De Quervain syndrome:
- Overuse of the thumb and wrist.
- Associated with pregnancy and breastfeeding.
- Can result due to rheumatoid arthritis.
- Repetitive gripping, lifting, and grasping the objects.
- Activities such as golfing, playing piano.
- Occupational and work related risk factors: Office worker and computer use for a long period.
Signs and symptoms of De Quervain syndrome :
- Main symptom: Pain at the radial” lateral” aspect of the wrist.
- Pain may arise gradually or suddenly.”
- Starts at the wrist and can referred to the forearm.
- The pain usually gets worse when the hand and thumb are in overuse.
- Aching, burning pain.
- Swelling over the thumb side. This swelling may be a fluid-filled cyst in the wrist region.
- snapping or catching sensation when moving the thumb.
- Restriction in wrist ROM.
- Weakness of the muscles of the forearm and wrist.
- Localized swelling and tenderness in radial styloid region.
- Trigger thumb.
- Superficial radial nerve neuritis.” Wartenberg’s syndrome”
- Arthritis in the first MCP joint is the main differential diagnosis for DQ.
- Scaphoid fracture.
- Radial styloid fracture.
Physical Examination for De Quervain syndrome:
Examine the hand if there’s any Pain or Swelling at the side of the thumb.
- Patient Position: sitting or standing.
- Patient hand is relaxed and comfortable.
- Therapist asked Px to make a fist with fingers wrapped around thumb.
- Therapist stabilizes the forearm and adducts the wrist “ ulnar deviation” >> strain to APL, EPB tendons.
- Test is Positive: pain at side of wrist. “ reproduction of Px symptoms “
Negative test: Px doesn’t feel any pain radiating up to the side of the thumb.
Management of De Quervain syndrome:
- Activity modifications.
- Surgery: applied only if conservative management is failed,
The main goal of surgery; to open the dorsal compartment of the sheath to make the irritated tendons more free.
The opening allows relief pressure of tendons, and restores free tendon gliding.
Physical therapy management:
- Ice/ heat.
In Acute stage, Ice applied to relieve inflammation of the tendon sheath.
Heat may help to relax and loose the tighten muscles.
- Rest: Immobilize the thumb and wrist.
- Thumb Splinting: keeps the thumb and wrist straight with a splint or brace, to make tendons rest.
- Ultrasound therapy.
- Mobilization with movement: “MWM” To relieve pain and improve the ROM of the wrist.
- Activity modification: avoiding repetitive thumb movements.
- Strengthening exercise: should be performed gradually after the pain is manageable, as:
- Isometric ex.
- Eccentric ex.
- Concentric ex.
- Radial nerve gliding.
you can watch the video about best 5 strengthening ex for more understanding.
- Taping therapy: can help to relieve pain and improve function and support for wrist joints.
- Massage: deep tissue massage to relieve pain and tightness for muscle of the thenar.
DQ tenosynovitis syndrome is a painful condition which affects the tendons on the thumb side of the wrist. If you have this syndrome you will feel an aching or burning pain when you turn your wrist or grasp an object or make a fist.
Recent Research reviews about DQ syndrome:
- De Quervain’s Tenosynovitis.(2022).Orthoinfo. https://orthoinfo.aaos.org/en/diseases–conditions/de-quervains-tendinosis/
- De Quervain’s Tenosynovitis.(N.D). Physiopedia. https://www.physio-pedia.com/De_Quervain%27s_Tenosynovitis
- De Quervain Tendinitis. (N.D). Slodeplayer. https://www.google.com/amp/s/slideplayer.com/amp/14766730/
- Yew, L. (2013). De quervain’s. Slideshare. https://www.slideshare.net/chongyewlee/de-quervains
- Finkelstein Test. (2022). Phsiopedia. Retrieved from https://www.physio-pedia.com/Finkelstein_Test