Wrist pain from de Quervain’s tenosynovitis is a common problem in my office. It’s notable from pain across the thumb side of the backhand aspect of the wrist which can extend into the thumb as well. It’s caused by the frictioning of two tendons in that part of the wrist inside a thickened connective tissue “wristband” called a retinaculum whose job is normally to hold the tendons snugly in place. When the retinaculum is thickened due to inflammation or injury the frictioning will in turn cause inflammation and pain at the tendons in question.
I see the condition often in new moms who are lifting babies all day and stressing the relevant tendons, although lots of other activities, including swinging hammers or lifting boxes can also cause the problem.
The treatment is multi-factoral. This is one of the (few) cases where I advocate bracing as an initial treatment. Many sources suggest using a thumb spika splint, but taping can also be tried as a less in your face option (see the picture below – The spika splint on the right and the tape job on the left modelled by yours truly!).
Manual therapy in the clinic can also be useful and at least one study has shown that patients respond well to a mulligan style mobilisation with movement delivered by a well trained clinician (like me!).
Exercise however is the thing that we are most interested in, this is where self care by an empowered client can make a huge difference. As with most tendon injuries I advocate for a stretch-eccentric strength-stretch protocol. This simple 3 step treatment option is easy to remember and the concept can be applied across various tendon injury sites as we have discussed in other blogs on tennis elbow and achilles tendonitis. In the video attached I explain how to execute the stretch and strength training exercise for de Quervain’s. Remember to start with 3 stretches, held for 30 seconds to 2mins, followed by 3 sets of 10 of the strength exercise, and finally 3 more stretches. See the video for specifics.
Finally I should mention that for de Quervain’s, cortisone injections are a commonly prescribed treatment intervention as well and this may have a role in the management of your injury. This is something that can be discussed in clinic and also with your physician.
If you have questions about this or any other physio related topic don’t hesitate to ask! I do respond to email (just give me a few days)!
Further reading (If you really want to impress your friends!)
D’Angelo, K., Sutton, D., Côté, P., Dion, S., Wong, J. J., Yu, H., … & Brown, C. (2015). The effectiveness of passive physical modalities for the management of soft tissue injuries and neuropathies of the wrist and hand: a systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Journal of manipulative and physiological therapeutics, 38(7), 493-506.
Huisstede, B. M., Coert, J. H., Fridén, J., & Hoogvliet, P. (2014). Consensus on a multidisciplinary treatment guideline for de Quervain disease: results from the European HANDGUIDE study. Physical therapy.
Rabin, A., Israeli, T., & Kozol, Z. (2015). Physiotherapy Management of People Diagnosed with de Quervain’s Disease: A Case Series. Physiotherapy Canada, 67(3), 263-267.
