Physiotherapy - De Quervain's Syndrome

What is Dequervain’s?

De Quervain’s Syndrome is painful condition of the tendon sheath surrounding two tendons of the thumb. It commonly causes pain and swelling near the base of the thumb, particularly when gripping, grasping or wringing.

These symptoms usually settle within a few months with the right management.

What causes De Quervain’s?

In many cases the cause of the condition is unknown. It is more common in women aged 30-55, particularly during and after pregnancy. It is considered to be an overuse injury, linked to repetitive movements at work or in sports. It can also be associated with previous injury or osteoarthritis of the thumb.

What are my treatment options?

In most cases, the symptoms need chance to settle, and you will make a full recovery from this. This can involve avoiding or adapting aggravating activities, splinting, taping or using topical creams or ice to aid in reducing inflammation.

There are several different modes of treatment available to you:

Splinting

Your therapist will likely provide you with a supportive splint, designed to restrict the movement of the involved tendons, in order to allow adequate rest/relief from inflammation.

There are several different options and your therapist will discuss these with you.

○    The splint should be worn at all times

○    The splint should be worn for aggravating activities

• Do not wear your splint for driving unless this has been agreed with your insurance company
• Do not wear your splint whilst operating machinery unless you have discussed this with your manager and an appropriate risk assessment completed
• Washing instructions are on the label
• If there is any redness/swelling/numbness/discomfort or increased pain stop wearing the splint and contact the department on 0161 206 5319

Adaptations

Where possible avoid aggravating activities until symptoms settle.

Where activities can’t be avoided wear a splint or look at modifications:

• Push/slide instead of lift
• Hold heavy objects close to body
• Use flat hand to carry plates etc
• Use assistive devices (electric screwdriver/tin opener)
• Adaptation of tools/pens to wide grip
• Alternate hands where possible
• Change grip so more comfortable

If you've had a baby:

• Where possible avoid picking baby up with thumb extended (scoop into forearms)
• Keep wrist in mid position and thumb close to hand when pushing pram, holding bottles
• Support baby on pillows when feeding
• Use sling to carry baby
• Baby clothes with easy fastenings

Medication

Non-steroidal Anti-inflammatory (NSAIDS) painkillers and gels can help to manage symptoms by reducing pain and inflammation.

Speak to your GP or local pharmacist to check you can take these and for advice on how to proceed.

Exercises

Your therapist will give you exercises depending on your length of condition as indicated below.

They are designed to maximise range of movement in the thumb and aim to increase the tensile strength of the tendons involved.

Stage 1

○    Dart throwers
3 sets of 15 repetitions, once a day

○    Resting hand on little finger side, lift and hold thumb away from hand
5 x 60 seconds, once a day

○    Resting hand over edge of table, lift and lower wrist
3 sets of 15 repetitions, once a day

Stage 2

○    Dart throwers with rolling pin. 50% grip around rolling pin
3 sets of 15 repetitions, once a day

○    Static hold against elastics band
5 x 60 seconds, once a day

○    ‘Hammer curl’ with hand weight. Lift wrist up with opposite hand and lower down on its own
3 sets of 15 repetitions, once a day.

Stage 3

○    Dart throwers with half full bottle of water
3 sets of 15 repetitions, once a day

○    Rest hand on little finger side, lift thumb up and down against elastic band
3 sets of 15 repetitions, once a day

○    Hand over the edge of table with small weight in hand. Lift and lower wrist slowly
3 sets of 15 repetitions, once a day

Ongoing Management

If conservative management is not successful, your therapist may consider further management options.

This may include a steroid injection for pain management and in more uncommon circumstances, referral for orthopaedic opinion.

Your Therapist’s name is:

Hand Therapy – 0161 206 5319. This is an answerphone service, so please leave a message or email hand.therapy@nca.nhs.uk