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De Quervain’s Tenosynovitis

What is it?  

De Quervain’s tenosynovitis is caused by irritation between the extensor pollicis brevis (EPB) and the abductor pollicis longus (APL) tendons of the thumb.  This creates a thickening and narrowing of the area in which they are housed over the bony area of the thumb on the side of your wrist. This causes inflammation and pain which becomes worse on moving the thumb or wrist and you may feel an associated ‘creaking’ around the tendons. 

The symptoms can start following prolonged or unusual activity such as gardening, DIY, or use of a gaming console.  

 It is also common in new mums although whether this is due to hormonal changes or repetitive lifting of the baby is unclear. 

See picture of a right hand and wrist. The blue arrow is the common site for De Quervain’s tenosynovitis.

How to manage it?

The majority of symptoms associated with De Quervain’s tenosynovitis will settle with rest and the correct changes to activity. Thumb movements such as gripping/pinching may worsen symptoms, so stopping the aggravating activities will help to settle the inflammation and pain.

Change your actions to reduce the stress on your wrists and take frequent breaks to rest if you are using your wrist a lot. Avoid repetitive and sustained wrist movements, particularly where the wrist is bent towards the palm and the thumb is spanning widely.

For new mums this may mean trying alternative ways of lifting your baby without scooping up under the arms and if finding bottle feeding painful try a bottle with a handle. If breastfeeding, try to relax your thumb and wrist once you have positioned your baby.  Avoid steering a pram one handed, this is very stressful for your wrist.

Swelling and pain can also be eased by applying an ice pack/frozen peas wrapped in a damp cloth for 10-15 minutes at a time, 3 times a day to the area.

  • Please note only use ice if you have normal skin sensation
  • Check the skin regularly
  • Stop if there is excessive pain, numbness or tingling
  • Do not put ice directly on to the skin as this may cause a burn

Simple painkillers

Painkillers like paracetamol will ease the pain, but need to be taken regularly in order to control the pain. Always follow the instructions on the packet.

Anti-inflammatories like ibuprofen can help with swelling, and therefore help you move more freely. Topical (applied directly on the affected body area) anti-inflammatories are recommended initially. Follow the instructions on the packet and discuss using them safely with a pharmacist, especially if you have any underlying health conditions

However, you should not take ibuprofen for 48 hours after an initial injury as it may slow down healing.

Up to date guidelines can be found on the NHS website:

Ibuprofen

Paracetamol

Other medicines can help to reduce inflammation, swelling and pain. You should discuss this with your GP if the simple pain relief advice does not help or if you are needing to take ibuprofen for more than 10 days.

You may benefit from using a splint that immobilises the wrist and thumb. There are a number places online you can purchase a De Quervains splint. Please see an example below of a splint that immobilises the wrist and thumb. There is evidence to suggest that only using the splint during painful activities can help but sometimes it is necessary to wear the splint continuously for up to 6 weeks to rest the tendons.  If you do need to wear the splint continuously, please take it off a few times a day for hand hygiene and to gently exercise the wrist and thumb to prevent stiffness.

Exercises

There is some evidence to suggest exercising the nerve can help the oxygen and blood flow.  Repeat this sequence x5 a few times a day.

Imagine you are holding some seeds as in the first picture, then gently move your arm away from your body as if scattering them. Follow the pictures below

1.

Move the wrist in a handshake action within comfort.

Repeat this 5 times.

2.

Bend the tip of the thumb joint whilst keeping the wrist still.

Repeat this 5 times.

3.

Bend the middle thumb joint whist keeping the wrist and thumb tip still.

Repeat this 5 times.

Please see an example of wrist and thumb splint below. You have to adjust your neoprene wrap. Please follow these fitting guidelines: 

The splint has two bars in it, one along the wrist and the other on the outside of the thumb. The thumb bar will need bending to fit. Follow the instructions below.

1.

When you remove the bar from its pocket it will be straight.

2. 

Bend it to the contour of your thumb and wrist for comfort. Slide it back into the pocket. 

3.

Undo the velcro straps and place the open splint on a table.  Slide your thumb through the thumb hole until the splint is snuggly fitting in to the thumb web. Place your hand palm down against the splint with the big knuckles of the fingers just over the edge of the splint material.

4.

Do the 3 straps up over the back of the wrist/ forearm. 

5. 

The strap closest to the fingers goes through the thumb web and fastens on the back of the hand. 

6.

The final fitting should look like this. Watch out for red marks on your skin due to rubbing or pressure points or a rash due to heat or allergy to the material.

Elastic or Neoprene splints may be hand-washed or machine-washed in an ‘easy care’ load (40°).  Make sure the Velcro straps are fastened before putting the splint in a washing machine or place it in a pillow case. 

 How to prevent De Quervain’s and manage flare ups?

The best way to prevent De Quervain’s tenosynovitis is to avoid repetitive movements as discussed above.  Once you have identified the causal activity, change your actions to reduce the stress on your wrists and take frequent breaks. 

Wear a thumb and wrist support as necessary but once you feel able to stop using it continually to avoid weakening and stiffening hand (usually 6 weeks).

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