De Quervain's Tenosynovitis in Northampton & Corby
Your Local Experts in Hand and Wrist Pain
Are you struggling with Hand and Wrist PAIN and looking for effective, professional treatment? At Team Rehab UK Ltd, our dedicated clinics in Brixworth and Corby offer premium physiotherapy services to help you regain your mobility and live pain-free. With a minimum of 24 years of experience each, our highly skilled chartered physiotherapists are committed to providing personalised care tailored to your specific needs.
Understanding De Quervain's Tenosynovitis
Introduction to De Quervain's Tenosynovitis
De Quervain's tenosynovitis is a condition that affects the tendons on the thumb side of your wrist. These tendons, called the extensor pollicis brevis and abductor pollicis longus, play a crucial role in thumb movement. They are surrounded by a protective sheath known as the synovium, which helps the tendons glide smoothly as you move your thumb. However, when these sheaths become inflamed and swollen, they can put pressure on nearby nerves, causing pain and discomfort. This condition is commonly referred to as De Quervain's syndrome or De Quervain's disease.
Anatomy of the Wrist and Hand
The foundation of the hand's structure lies in its bones, which provide the necessary support and shape. The wrist itself is made up of eight small bones known as carpal bones. These bones are connected to the two long bones of the forearm—the radius and the ulna—to form the wrist joint. The wrist joint plays a crucial role in the hand's ability to move and bear weight.
From the wrist, the hand extends into five metacarpal bones that form the palm. Each of these metacarpal bones connects to a finger at a joint known as the metacarpophalangeal (MCP) joint, commonly referred to as the knuckle joint. This joint allows the fingers to flex and extend, essential movements for gripping and holding objects.
The fingers themselves are composed of bones called phalanges. Each finger contains three phalanges, separated by two joints known as interphalangeal joints.
The thumb, however, is unique in that it has only two phalanges and one interphalangeal joint. The first joint, located closest to the knuckle, is called the proximal interphalangeal (PIP) joint, while the joint near the fingertip is the distal interphalangeal (DIP) joint. These joints work together like hinges, enabling the fingers to bend and straighten with ease.
Muscles Involved in De Quervain's Tenosynovitis
De Quervain’s tenosynovitis primarily affects two key muscles located on the thumb side of the wrist:
Extensor Pollicis Brevis (EPB): This muscle is responsible for extending the thumb, allowing you to move it away from the palm. It plays a critical role in actions like giving a thumbs-up or reaching out to grasp objects.
Abductor Pollicis Longus (APL): This muscle helps to abduct the thumb, which means it moves the thumb away from the hand, allowing for a broader range of motion. This action is essential for gripping and manipulating objects.
Both of these muscles are encased in a tendon sheath that allows them to glide smoothly as you move your thumb. When the sheath becomes inflamed, it restricts the movement of these tendons, leading to the pain and discomfort characteristic of De Quervain’s tenosynovitis.
Recognising the Symptoms on De Quervain's Tenosynovitis
De Quervain’s tenosynovitis is often characterised by a distinct set of symptoms that primarily affect the thumb side of the wrist. The hallmark symptom is pain, which is typically felt at the base of the thumb and can radiate up the forearm. This pain may be sharp or aching and often worsens with movements that involve grasping, pinching, or twisting the wrist. Everyday activities such as lifting a baby, opening jars, or even texting can become increasingly difficult and painful.
Alongside pain, you may notice swelling around the affected area, which can be accompanied by a visible bump along the thumb side of the wrist. This swelling is due to inflammation of the tendon sheath and can lead to tenderness when pressing on the affected area. The skin over the swollen area might also appear red and feel warm to the touch, indicating active inflammation.
A less common but equally troubling symptom is a catching or snapping sensation, sometimes described as a "sticking" feeling, when moving the thumb. This occurs because the inflamed tendons are struggling to glide smoothly within their sheath, leading to a jerky or uneven movement. In severe cases, this can result in a complete loss of thumb mobility, significantly impacting your ability to perform everyday tasks.
Diagnosis of De Quervain's Tenosynovitis
Accurate diagnosis of De Quervain’s tenosynovitis is essential for effective treatment. The diagnostic process begins with a thorough review of your symptoms and medical history. Your physiotherapist in Northampton will ask detailed questions about your daily activities, any recent injuries, and any underlying health conditions such as rheumatoid arthritis that might contribute to the condition.
A physical examination of the wrist and thumb is then performed to assess the severity of the inflammation and pinpoint the exact location of the pain. One of the key diagnostic tests used is the Finkelstein test. This simple yet effective test helps to confirm the presence of De Quervain’s tenosynovitis:
The Finkelstein Test Procedure: Your physiotherapist will ask you to make a fist with your fingers wrapped around your thumb, securing it inside your hand. Once your fist is formed, you will be instructed to bend your wrist towards the little finger, a movement known as ulnar deviation.
Interpreting the Results: If this movement triggers sharp pain along the thumb side of your wrist, it strongly suggests that the tendons involved in De Quervain’s tenosynovitis are inflamed. The intensity of the pain during this test can also give your physiotherapist an indication of the severity of the condition.
Ensuring Optimal Treatment Outcomes
At Team Rehab UK, we emphasise that treatments which are not effective should not continue beyond accepted clinical timescales without further in-depth investigations. We prefer these additional assessments to be conducted by consultant specialists outside our company’s financial interests. This approach ensures we receive an unbiased second opinion, guaranteeing that the care you receive is the most clinically appropriate.
Blood Vessels of the Wrist and Hand
Treating De Quervain’s tenosynovitis involves a strategic approach that prioritises nonsurgical methods, aimed at alleviating pain, reducing inflammation, and restoring the function of the thumb and wrist. These treatment options are tailored to the severity of the condition, the patient’s lifestyle, and how the symptoms respond to initial interventions.
1. Rest and Activity Modification:
The first and most critical step in managing De Quervain’s tenosynovitis is to minimise or eliminate activities that exacerbate the symptoms. Activities that involve repetitive thumb and wrist movements, such as texting, typing, or lifting, should be avoided or significantly reduced.
To further reduce strain on the affected tendons, a physiotherapist in Northampton may recommend wearing a thumb spica splint. This splint immobilises the thumb and wrist, allowing the inflamed tendons to rest and heal. The splint is typically worn throughout the day and night for a few weeks, depending on the severity of the condition. This approach can significantly reduce pain and prevent further irritation of the tendons.
2. Physiotherapy:
Physiotherapy plays a pivotal role in the treatment of De Quervain’s tenosynovitis, as it helps to restore strength, flexibility, and function to the wrist and thumb. A tailored exercise program, designed by a physiotherapist in Northampton, will focus on:
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Stretching Exercises: Gentle stretches can help to increase flexibility in the wrist and thumb, reducing stiffness and improving range of motion. Stretching the tendons that pass through the first dorsal compartment (where the inflammation occurs) can also help to relieve pressure and reduce pain.
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Strengthening Exercises: As the inflammation subsides, strengthening exercises are introduced to improve the stability and strength of the wrist and thumb. Strengthening the surrounding muscles helps to distribute the load more evenly, reducing the strain on the affected tendons. Depending on the stage and presentation these could be concentric, eccentric or isometric, in nature.
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Manual Therapy: Techniques such as soft tissue mobilisation, massage, and joint mobilisation can be employed by the physiotherapist to improve circulation, reduce muscle tension, and promote healing in the affected area.
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Taping: Kinesio taping can be applied by one of our specialists to help offload and support, the most inflamed structures in an attempt to help your natural healing between sessions. We have multiple 'Roc Docs' on site so we are able to tape not only with conventional techniques, but also include more bespoke options, in necessary, to your individual needs.
For patients who also experience shoulder pain Northampton due to compensatory movements or related musculoskeletal issues, shoulder physiotherapy in Northampton may be incorporated into the treatment plan.
Addressing any related shoulder dysfunctions can help to improve overall upper limb function and prevent further strain on the wrist and thumb.
3. Medications
In conjunction with rest and physical therapy, medications can be an effective tool in managing the symptoms of De Quervain’s tenosynovitis. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, are commonly used to reduce inflammation and relieve pain. These medications can be taken orally or applied topically in the form of gels or creams but due to their side effects in certain patient populations, and interaction with other medications, professional advice should be sought prior to starting any drug regime.
If the pain and inflammation are severe or persistent, your consultant in Northampton might recommend a corticosteroid injection. This involves injecting a potent anti-inflammatory medication directly into the tendon sheath. The corticosteroid works by reducing the inflammation within the sheath, thereby relieving pain and restoring movement. The effects of the injection can last for several weeks to months, and in many cases, a single injection is sufficient to resolve the symptoms.
4. Advanced Non-Invasive Therapies
Some clinics may offer advanced non-invasive therapies in situations where healing has not advanced as expected. At Team Rehab uk we favour Shockwave therapy in these situations. If this is a clinically suitable option for you, you can discuss this with your physiotherapist.
When Surgery is Needed
If conservative treatments fail to provide sufficient relief, and the condition significantly impairs daily activities, your consultant in Northampton may suggest surgical intervention, although this is rare. Surgery for De Quervain’s tenosynovitis is typically performed on an outpatient basis and is designed to relieve the pressure on the inflamed tendons by releasing the constricted tendon sheath.
1. Surgical Procedure
The surgical procedure, known as first dorsal compartment release, involves making a small incision over the affected area of the wrist. The surgeon carefully cuts open the tendon sheath, creating more space for the tendons to move freely.
This release alleviates the pressure, allowing the tendons to glide smoothly without causing pain. The incision is then closed with sutures, and a dressing or splint is applied to protect the area during the initial healing phase.
2. Post-Surgical Rehabilitation
Post-operative care is crucial for a full recovery. Immediately after surgery, your wrist and thumb may be immobilised in a splint to protect the surgical site and reduce swelling. As healing progresses, your physiotherapist in Northampton will guide you through a comprehensive rehabilitation program that includes:
Gradual Mobility Exercises: Early-stage exercises focus on gently restoring movement to the wrist and thumb without placing undue stress on the healing tendons.
Strengthening and Conditioning: As the surgical site heals, more advanced exercises are introduced to rebuild strength, enhance flexibility, and restore full function.
Scar Management: Techniques such as massage and gel application may be recommended to minimise scar tissue formation and improve the appearance and function of the surgical site.
The goal of post-surgical rehabilitation is to ensure that you regain full use of your thumb and wrist, minimise the risk of recurrence, and return to your daily activities without pain. Regular follow-up appointments with your consultant and physiotherapist will help monitor your progress and make any necessary adjustments to your treatment plan.
We have included this video animation to help you visualise the anatomy that we, as professionals, often take for granted. At Team Rehab UK, we are dedicated to helping our patients understand the causes of their symptoms, empowering them to effectively manage their condition both during and after their treatment.
Please note that some of our videos may be of American origin and might contain slightly different professional terms or approaches compared to those used in the UK. However, the content remains highly informative and beneficial. You should seek advice form your UK based specialist before trying any advice contained, or inferred, in the video you ensure it complies with UK best practice standards.
Summary
De Quervain’s tenosynovitis can significantly impact your quality of life, but with the right treatment approach, relief is within reach. Whether through conservative management with rest, physiotherapy, and medications, or surgical intervention when necessary, the key to successful treatment lies in early diagnosis and a tailored approach.
At Team Rehab in Northampton (Brixworth) and Corby, we are committed to providing personalised care that addresses your unique needs. If you’re dealing with persistent wrist or thumb pain, don’t wait to seek help. Contact us today to schedule a consultation with one of our experienced physiotherapists or consultants. We’re here to help you get back to living pain-free.
And remember, if you found this information helpful, please share it with someone who might benefit. Whether through a personal recommendation or a social media post, spreading the word can help others find the relief they need.
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