Treatment of de Quervain’s Disease (Stenosing Tenosynovitis of the Thumb)
de Quervain’s disease is an inflammatory condition affecting the tendons of the thumb, especially at the base of the thumb). All tendons run through tunnels called sheaths and when tendons swell they can rub against their protective sheath and cause pain and inflammation. This condition is mainly seen in repetitive motions such as racquet sports, using a hammer, or any condition where the wrist is repeatedly moved from side to side.
Pain with de Quervain’s disease is felt at the base of the thumb in the dorsal aspect of the hand, where the thumb and wrist meet. Pain increases when moving the thumb or when moving the wrist side to side. An orthopedic test used by the majority of physicians to diagnose this condition is called Finkelstein’s test. During this test the patient makes a fist with the thumb inside the fingers and moves the fist down. If the test is positive, the patient will feel pain at the base of the thumb.
Treatment for this condition includes splinting, rest, ice, and therapeutic ultrasound. Since it is an overuse injury, it requires inactivity to return to normal and this is why splinting is recommended. Ice can be used as a natural analgesic and to relieve some of the swelling associated within the tendons. Due to the lack of nutrients tendons receive, its recovery usually takes long and with the use of therapeutic ultrasound you can easily increase the local circulation to speed up recovery. Therapeutic ultrasound will also help to reduce the swelling and break up any scar tissue that may have formed as a result of the injury.
Once the patient’s pain has diminished and range of motion is restored, to reach maximal recovery the patient should focus on strengthening the thumb, hand, and wrist to avoid a recurrence. If necessary, modifications should be made to avoid repetitive motions that cause pain.