De Quervain's tenosynovitis, or Mommy's thumb

 

 What is De Quervain's tenosynovitis?

Inflammation of the wrist tendons on the thumb side. Pinching, gripping, or rotating the wrist can aggravate de Quervain tenosynovitis, causing pain and tenderness in the area surrounding the thumb.

Why is it known as Mommy's thumb?

It arose because the condition is frequently seen in new mothers due to the repetitive motions involved in caring for an infant. These motions can strain the tendons at the base of the thumb. 

not just for mothers. Although it is common in newlyweds, anyone who engages in repetitive activities that strain their thumb and wrist may develop De Quervain's tenosynovitis.

you will read this blog......

• What is De Quervain's tenosynovitis?
• Why is it known as Mommy's thumb?
• Causes and Symptoms of De Quervain's Tenosynovitis.
• Complications of De Quervain's Tenosynovitis.
• Can De Quervain's cause permanent damage?
• Physiotherapy Treatment for De Quervain’s Tenosynovitis.

Causes and Symptoms of De Quervain's tenosynovitis

Causes

• Repeat a specific task day after day.
• Inflammatory arthritis, such as rheumatoid arthritis,.
• Direct injury to the wrist or tendon
• Gripping tools tightly
• Repetitive pinching or grasping
• Using poor posture while using your hands
• Certain sports, such as racquetball, skiing, and rock climbing,
• Diabetes
• Retention of fluid, such as that caused by hormonal fluctuations during pregnancy
• overuse of the thumb and wrist.
• More women than men are affected by it, and it is most prevalent in those between the ages of 30 and 60. with a predicted prevalence of 0.5% for men and 1.3% for women.
• It is also associated with pregnancy and breastfeeding.

Symptoms

 

• The activity could make the pain worse.
• discomfort in the area of the thumb's base
• Having trouble moving the thumb and wrist when grasping or pinching something
• a sensation of "sticking" or "stop-and-go" when using the thumb
• On the wrist's thumb side, you might experience pain.
• surrounding the base of the thumb, swelling
• Handling objects with difficulty
• a catching or grinding feeling in the thumb
• a thumb weakness

Which nerve is affected in Dequervains?

There isn't a direct nerve that's affected. The condition primarily impacts the tendons and their surrounding sheath at the base of the thumb. Repetitive motions cause inflammation in the tendons (abductor pollicis longus and extensor pollicis brevis) and their sheath (tenosynovitis). This inflammation narrows the space around the tendons, compressing them and causing pain. In some cases, the inflamed tenosynovitis may press on a nearby nerve, the superficial radial nerve. This can lead to tingling or numbness radiating along the thumb side of the hand, but it's not the main issue.

What makes De Quervain's worse?

Risk factors for de Quervain tenosynovitis include:

1. Age. People between the ages of 30 and 50 have a higher risk of developing de Quervain tenosynovitis than do people in other age groups, including children.
2. Sex. The condition is more common in women.
3. Pregnancy. The condition may be associated with pregnancy.
4. Baby care. Lifting a child repeatedly involves using the thumbs as leverage and may be associated with the condition.
5. Jobs or hobbies that involve repetitive hand and wrist motions. 
6. Repetitive motions
7. Poor posture: If you use your hands for extended periods and maintain poor hand and wrist posture, this can put additional strain on the tendons and increase the risk of irritation.
8. Not resting the thumb: Even if you reduce overall activity, continuing to use your thumb in everyday tasks without allowing it to heal can slow recovery.
9. Certain health conditions: Inflammatory arthritis like rheumatoid arthritis can contribute to inflammation in the tendons and worsen De Quervain's.
10. Sudden increases in activity: If you've been resting your thumb and then suddenly jump back into strenuous activities that involve gripping or pinching, it can aggravate the condition.

Complications De Quervain's Tenosynovitis 

Proper use of the hand and wrist may become challenging if de Quervain tenosynovitis is left untreated. Some range of motion may be lost in the wrist.

The pain may extend further into the thumb, forearm, or both if the condition is left untreated for an extended period. Thumb and wrist movements could exacerbate the pain.

What is the test of Quervain?

You may be asked to perform a Finkelstein test. 

• The examiner will ask you to make a fist with your affected hand, keeping your thumb tucked inside.
• The examiner will then gently grasp your thumb and bend your wrist towards your pinky finger (ulnar deviation). They may also apply some gentle traction along the length of your thumb.

Finkelstein's test is considered positive if you have increased pain at the base of your thumb, particularly along the path of the tendons, and possibly some pain radiating toward your wrist. This suggests De Quervain's tenosynovitis may be present.

Note that other conditions can cause pain comparable to what is experienced with Finkelstein's test, so it is important to keep that in mind. A doctor will consider your medical history, symptoms, and the results of the test, along with other examinations, to make a definitive diagnosis.

Imaging tests, such as MRI

Can De Quervain's cause permanent damage?

Although it is not guaranteed, De Quervain's tenosynovitis may result in irreversible harm.

• Generally temporary: De Quervain's tenosynovitis is typically a transient condition that goes away entirely in a few weeks or months with the right diagnosis and care. The majority of patients regain full thumb function.
• The risk of permanent damage increases with neglect. Neglect increases the chance of long-term harm. An extended period of untreated inflammation can exacerbate and lead to problems that might last a lifetime.

Physiotherapy Treatment for De Quervain’s Tenosynovitis

Goals of treatment

• Ease the pain and swelling of your wrist.
• Keep the joints in your wrist working normally.
• Stop this condition from coming back.

1. Reduce the pain and swelling in your wrist.

de quervain's tenosynovitis splint

• Immobilizing the thumb and wrist and keeping them straight with a splint or brace to help rest the tendons
• Avoid repetitive thumb movements as much as possible.
• Avoid pinching with the thumb when moving the wrist from side to side.
• Applying ice to the affected area reduces pain and swelling. Place an ice pack or cold pack on your wrist for 10 minutes.
• Applying ultrasound therapy to reduce pain and swelling

Taking nonsteroidal anti-inflammatory drugs (NSAIDs). 

• Ibuprofen (Advil®, Motrin®)
• Naproxen (Aleve®, Naprosyn®)
• Celecoxib (Celebrex®)
• Meloxicam (Mobic®)
• Diclofenac (Voltaren®)

NSAIDs may cause side effects. Ask your healthcare provider if they are safe for you to take.

2. Gain normal movement.

• Abductor pollicis longus strengthening: Place your hand in front of you and hold your opposite finger against your opposite thumb. Try to push your thumb away from the midline of your hand, but use your opposite finger to resist the movement.

• Isometric finger extension: Place your injured hand on a flat surface and lift all your fingers upwards off the surface together. Use this exercise to strengthen your finger tendons.

• Radial deviation isometric: Rest your hand on a table with your thumb facing up. Resist moving your hand in the direction of your thumb. The hand should not move. This is a strengthening exercise for the wrist, forearm, and elbow.

• Thumb and fingerband strengthening: Wrap an elastic band around your fingers and thumb. Pull your fingers and thumbs apart from each other against the resistance of the band. This exercise will help strengthen your joints.

• Wrist flexion with a band: Rest your hand and wrist on a table. Hold an exercise band and bend your wrist to create resistance in the band. This is a strengthening exercise for your wrist, forearm, and elbow.

• Taping can also be used to enhance function and lessen pain.

3. Avoid worsening De Quervain's

Maintain a neutral wrist position while using your hands. When engaging in activities that stress your thumb, take frequent breaks to rest and stretch your hand and wrist. When lifting objects, use your whole hand and forearm to distribute the weight, reducing stress on the thumb. Apply ice packs to the affected area for 10–15 minutes at a time, several times a day, to reduce inflammation.

Citation 

Paries, C. (2020, November). Mommy Thumb – Morbus de Quervain bei Müttern. Ergopraxis, 13(11/12), 38–41. https://doi.org/10.1055/a-1236-9661

&NA; (2008, July). Anastrozole/exemestane. Reactions Weekly, NA;(1211), 7. https://doi.org/10.2165/00128415-200812110-00021

Caruthers, L. B. (2020, July). De Quervain tenosynovitis. JAAPA, 33(7), 49–50. https://doi.org/10.1097/01.jaa.0000668844.44726.68

Paries, C. (2024, January). Mommy Thumb. Praxis Handreha, 05(01), 26–29. https://doi.org/10.1055/a-2164-5803

 Berger, M. R. (1982, September). Painful Tendon Problems of the Hand. Orthopaedic Nursing, 1(5), 20-23???23. https://doi.org/10.1097/00006416-198209000-00004