De Quervain's Tenosynovitis

Comprehensive guide to understanding, treating, and preventing De Quervain's tenosynovitis through evidence-based rehabilitation and activity modification strategies.

6:1

Female to male ratio

4-8

Weeks to recover

90%

Success with conservative care

30-50

Peak age range

Understanding De Quervain's Tenosynovitis

What is De Quervain's Tenosynovitis?

De Quervain's tenosynovitis is inflammation of the tendons and tendon sheath on the thumb side of the wrist, affecting the abductor pollicis longus and extensor pollicis brevis tendons.

Common Risk Factors:

Repetitive thumb and wrist motions
Pregnancy and postpartum period
Age 30-50 years
Occupational overuse

Common Symptoms

Pain at base of thumb and wrist
Swelling along thumb side of wrist
Pain worsening with thumb movement
Difficulty gripping or pinching
Positive Finkelstein test
Catching or sticking sensation

Types of De Quervain's Tenosynovitis

Acute De Quervain's

Sudden onset inflammation often related to specific activity or injury

Common Causes:

Sudden increase in thumb/wrist use
Direct trauma to thumb side of wrist
New repetitive activity
Hormonal changes (pregnancy/menopause)

Symptoms:

Sharp pain with thumb movement
Swelling at base of thumb
Positive Finkelstein test
Pain worsening with gripping

Treatment Approach:

Rest, splinting, anti-inflammatory treatment, and activity modification

Chronic De Quervain's

Long-standing inflammation with persistent symptoms over months

Common Causes:

Repetitive thumb and wrist motions
Occupational overuse patterns
Poor ergonomics
Previous inadequately treated acute episode

Symptoms:

Persistent aching pain
Morning stiffness
Weakness with pinching
Thickening of tendon sheath

Treatment Approach:

Comprehensive rehabilitation, ergonomic modification, possible injection therapy

Treatment Phases

Phase 1: Acute Management (0-2 weeks)

Initial inflammation control and pain reduction

Goals:

Reduce inflammationControl painProtect healing tissues

Key Interventions:

Thumb spica splinting for rest

Ice therapy 15-20 minutes, 3-4 times daily

Anti-inflammatory medications as prescribed

Activity modification and avoidance of aggravating movements

Gentle range of motion within pain limits

Ergonomic assessment and workplace modifications

Phase 2: Progressive Mobilization (2-6 weeks)

Gradual restoration of movement and function

Goals:

Restore range of motionBegin strengtheningImprove function

Key Interventions:

Progressive splint weaning

Tendon gliding exercises

Gentle stretching program

Manual therapy techniques

Activity-specific training

Ergonomic tool introduction

Phase 3: Strengthening & Return (6-12 weeks)

Progressive strengthening and return to full activities

Goals:

Build strength and endurancePrevent recurrenceReturn to activities

Key Interventions:

Progressive resistance training

Functional activity training

Endurance building exercises

Sport/work-specific conditioning

Long-term prevention strategies

Maintenance exercise program

Rehabilitation Exercise Program

Acute Phase Exercises (0-2 weeks)

Gentle Thumb Range of Motion

Passive and active-assisted thumb movements within pain limits

Sets: 2-3 sets

Reps: 10-15 repetitions

Frequency: 3-4 times daily

Ice Application

Apply ice to reduce inflammation and pain

Sets: 1 application

Reps: 15-20 minutes

Frequency: 3-4 times daily

Splint Wearing

Thumb spica splint for rest and protection

Sets: Continuous wear

Reps: As tolerated

Frequency: Especially during activities

Mobilization Phase (2-6 weeks)

Tendon Gliding Exercises

Gentle movements to promote tendon mobility

Sets: 3 sets

Reps: 10-15 repetitions

Frequency: 2-3 times daily

Thumb Stretches

Gentle stretching of thumb muscles and tendons

Sets: 3 sets

Reps: 30-second holds

Frequency: 2-3 times daily

Wrist Mobility

Gentle wrist movements to maintain flexibility

Sets: 2-3 sets

Reps: 10-15 repetitions

Frequency: Daily

Strengthening Phase (6-12 weeks)

Thumb Opposition Exercises

Strengthen thumb muscles with resistance

Sets: 2-3 sets

Reps: 10-15 repetitions

Frequency: Daily

Grip Strengthening

Progressive grip strengthening with therapy tools

Sets: 2-3 sets

Reps: 10-15 repetitions

Frequency: Daily

Functional Activities

Practice daily activities with proper mechanics

Sets: 2-3 sets

Reps: 5-10 minutes

Frequency: Daily

Prevention Strategies

Avoid repetitive thumb and wrist motions

Take frequent breaks during activities

Use ergonomic tools and proper technique

Maintain neutral wrist and thumb positions

Strengthen thumb and wrist muscles regularly

Modify activities that cause pain

Use proper lifting and gripping techniques

Address early symptoms before they worsen

When to Seek Medical Attention

Severe, constant pain not relieved by rest

Numbness or tingling in thumb or fingers

Complete inability to move thumb

Signs of infection (fever, increased warmth, redness)

No improvement after 2 weeks of conservative treatment

Progressive weakness in grip strength

Visible deformity or swelling

Symptoms interfering with sleep or daily activities

Thumb Splints

Spica splints for rest and protection

Ice Therapy

Cold packs for inflammation control

Therapy Tools

Exercise tools for strengthening

Carpal Tunnel Syndrome Back to Wrist Conditions Trigger Finger

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