De Quervain’s Tenosynovitis / Abductor Pollicis Longus Tenosynovitis
De Quervain’s tenosynovitis is the inflammation of tendons on the side of the wrist at the base of the thumb. These tendons include the extensor pollicis brevis and the abductor pollicis longus tendons.
The most common cause of the disorder is overuse injury involving the wrist and often occurs in individuals who regularly use a forceful grasp coupled with ulnar deviation of the wrist (such as a tennis serve).
This injury occurs because of inflammation around the tendon sheath of the abductor pollicis longus and extensor pollicis brevis in the first dorsal compartment. Pain and tenderness over the radial aspects of the wrist are the typical presenting symptoms.
De Quervain’s tenosynovitis can be brought on by simple strain injury to the extensor pollicus longus tendon. Typical causes include stresses such as lifting young children into car seats, lifting heavy grocery bags by the loops, while playing tennis/badminton and lifting gardening pots up and into place.
Finklestein test is one of the diagnostic procedure for De Quervains tenosynovitis. This test places stress on the abductor pollicis longus and extensor pollicis brives by placing the thumb into the palm of a fist then ulnarly deviating the wrist. Mild De quervains may present with pain only on resisted thumb meta carpal joint extension.
In acute stage physiotherapy treatments are splints to support the thumb and the wrist in functional position, identify the aggravating activities and suggest alternative postures to avoid this movements. Massage transversely over the tendon. Instruct the patient to do tendon-gliding exercise to prevent adhesions.
Cryotherapy is advised (eg, cold packs, ice massage) to reduce the inflammation and edema. Phonophoresis with Ultrasonic massage using non steroidal anti- inflammatory gel or Iontophoreis. suggesting activity modifications for reduce the stress and strain over the tendons.
In chronic stages, thermal modalities like short wave diathermy is used. Transverse friction massage is applied over the tendons. Splinting the related joint to rest the involved tendons. Assess the bio-mechanics of the functional activity that provoking the symptoms and design a program to regain a balance in the length, strength and endurance of the muscles. Therapeutic exercises-starting with range of motion exercises, Gliding Sliding movements of the joint and as the patient progresses, adding strengthening exercises. Ergonomic workstation assessment as needed and redesign the station to avoid the unusual movements of the joints. Educating the patient to either avoid or decrease repetitive hand motions, such as pinching, wringing, turning, twisting or grasping and Advised home-exercise program to strengthening the muscles and tendons.