De Quervain's tenosynovitis refers to inflammation of the tendons in the thumb. The condition makes it painful when a person moves their thumb.
There are some exercises that people can do at home to help alleviate the symptoms. This article describes what to do.
The condition was named after the Swiss surgeon Fritz de Quervain, who identified it first in 1895.
De Quervain's tenosynovitis is the inflammation of the sheath, or synovium, that surrounds the two tendons that run between the wrist and the thumb.
Tendons are strong bands of tissue that attach muscles to bone. In the thumb, they are involved in moving the thumb.
As the synovium swells and thickens, it becomes painful for a person to move their thumb.
It usually occurs after the thumb or wrist has been overused, particularly during repetitive activities that move the thumb away from the wrist.
A sprain or overusing the tendons through repetitive movements of the thumb at work or during sport tend to make the swelling and pain worse.
Activities linked to De Quervain's include:
- playing the piano
- carrying a child
The condition is more common in women than men and often happens after pregnancy.
Other causes include scar tissue formation from an injury or inflammatory arthritis.
The main symptoms are pain and swelling at the base of the thumb.
These lead to:
- pain when moving the thumb or wrist
- pain when making a fist
- swelling and tenderness on the side of the wrist
- feeling or hearing creaking as the tendons slide through the sheath
- reduced grip strength
Movements that involve the thumb and wrist, including pinching, grasping, or wringing will make the pain worse.
People with De Quervain's tenosynovitis are usually recommended to wear a splint for 2 to 3 weeks.
During this time, the splint can be removed to carry out the following exercises.
1) The individual places the affected hand palm down on a flat surface, such as a table. With the other hand, the affected thumb is gently moved away from the table then replaced slowly and smoothly. This movement should be repeated 5 to 10 times.
2) The person places the affected hand sideways, little finger first, on a flat surface. With the other hand, the affected thumb is moved away from the fingers, then brought back in line with them. The movement is repeated 5 to 10 times.
3) The affected hand is placed flat on the table, palm first. Keeping the hand still, the thumb is moved out to the side, as far as feels comfortable, then returned. The exercise is repeated 5 to 10 times.
4) Once exercise three has ceased to cause pain, it can be carried out with the wrist off the edge of the table.
5) With the palm down on the table, the individual should lift the thumb, as far away from the surface as possible, then bring it back down. This is repeated 10 times, increasing repetitions, as the movement becomes more comfortable.
6) An elastic band is placed around the fingers and thumb, and the thumb is moved against the resistance of the band 10 times.
7) Resting the affected hand on the table palm up, the person touches the top of the thumb to the little finger. The stretch is held for 6 seconds and done 10 times.
8) Holding the affected arm out in front, the person uses the other hand to press down the back of the hand, stretching the wrist. The position is held for 15 to 30 seconds and repeated three times.
9) As above, but the other hand is used to push the hand upwards, stretching the wrist in the other direction. The stretch is held for 15 to 30 seconds and repeated three times.
10) Holding a can in the affected hand, with the palm facing up, the individual can lower the weight then return to the starting position. Two sets of 15 are recommended.
11) The person holds a can and places the wrist in a sideways position with the thumb at the top. They then gently bend their wrist up, with the thumb reaching towards the ceiling, then gently lower to the starting position, all without moving the forearm. Two sets of 15 are advised.
12) A person can strengthen their grip by squeezing a soft rubber ball and holding the stretch for 5 seconds. Two sets of 15 are recommended.
Preparing for the exercises
These exercises should be used for rehabilitation and only done once the initial pain has eased.
The first step to tackling De Quervain's tenosynovitis is resting from the activity or activities that have caused the pain. Wearing a splint and regularly applying heat or cold packs will also help.
If the exercises make the pain worse, or if the pain does not reduce after 4 to 6 weeks, people are advised to speak to a doctor.
The Finkelstein's test is used for diagnosis of the condition. This is performed by the person placing their thumb in the palm of their hand and making a fist. They will then be asked to bend their wrist in the direction of their little finger.
The test for De Quervain's tenosynovitis is positive if this makes the pain worse.
The individual is usually referred to a physiotherapist or hand specialist for treatment, including exercises, such as those described above.
As well as exercises, treatment will also include rest, anti-inflammatory painkillers, and wearing a splint. If someone is still suffering symptoms after therapy, steroid injections may be used to reduce the swelling.
If the symptoms do not ease after treatment, a doctor may recommend an ultrasound to try to establish if there is some other reason for the pain. In some cases, the condition can be eased with an operation.