De Quervain's Tenosynovitis is a painful inflammation of tendons on the side of the wrist at the base of the thumb. These tendons include the extensor pollicis brevis (EPB) and the abductor pollicis longus (APL). These muscles are located on the dorsal side of the forearm and go to the lateral side of the thumb through a fibrous-osseous tunnel made of the processus styloideus radii and the extensor retinaculum. The pain, which is the main complaint, gets worse with the abduction of the thumb, grasping action of the hand, and an ulnar deviation of the wrist. Thickening and swelling can also be present
It is associated with repetitive wrist motion, specifically motion requiring thumb radial abduction and simultaneous extension and radial wrist deviation. Activities such as golfing, playing the piano, fly fishing, carpentry, office workers and musicians can lead to chronic overuse injuries. Repetitive gripping, grasping, clenching, pinching, or wringing of objects can cause inflammation of the tendons and tendon sheaths and narrows the first dorsal compartment and causes limitation of motion of the tendons. If left untreated, the inflammation and progressive narrowing (stenosis) can lead to scarring that further limits thumb motion.
The primary complaint is radial sided wrist pain that radiates up the forearm with grasping or extension of the thumb. The pain has been described as a “constant aching, burning, pulling sensation." Pain is often aggravated by repetitive lifting, gripping, or twisting motions of the hand. Swelling in the anatomical snuff box, tenderness at the radial styloid process, decreased CMC abduction ROM of the 1st digit, palpable thickening of the extensor sheaths of the 1st dorsal compartment and crepitus of the tendons moving from the extensor sheath may be found upon examination. Other possible findings include weakness and paresthesia in the hand. Finkelstein’s diagnostic test will present positive provoking the patient’s symptoms.
Physical Therapy Management:
Physical therapists can give advice on modifications of activities and the workplace (ergonomic modifications), task modification, For example, taking sufficient rest and variation of movements. Often simple obvious alterations to the working practice can be beneficial in controlling milder symptoms of CTS. Manual therapy techniques include mobilization of soft tissue, carpal bones, and median nerve. Other modalities include: ultrasound and splinting.