De Quervain’s Tendinitis

The acute pain in the back of your wrist, on the thumb side, can make even the simplest activities challenging. De Quervain's tendinitis may be the cause of that burning feeling in your hand when you hold a coffee mug, turn a doorknob, or pick up your child. This is a work, hobby, and quality-of-life-disrupting condition that is brought about by inflammation of the tendons that control the movement of your thumb. 

Although the pain may be too much, there are viable and noninvasive remedies. The first conservative treatment is physical therapy, which directly addresses the mechanical problems underlying the inflammation without injections or surgery.

At Suarez Physical Therapy, our committed physiotherapists in Las Vegas will develop a tailored recovery plan to relieve your pain, restore your function, and educate you on how to prevent it. We will also work to ensure that you are back to a life free of wrist and thumb pain.

Identifying Symptoms of De Quervain’s Tendinitis

The symptoms of De Quervain tendinitis may at first present themselves as a dull, persistent pain at the bottom of your thumb, just at the point where it joins the wrist. This pain may, over time, become sharp and radiate up your forearm or down to your thumb. The condition explicitly affects two tendons, namely abductor pollicis longus and extensor pollicis brevis, and the synovial sheath that surrounds them. When such a sheath is inflamed, the tendons do not glide smoothly, and the movement is limited, thus resulting in friction and much pain with almost every movement.

Pain and Tenderness at the Base of the Thumb

The main sign of this disorder is pain in the region over the radial styloid, the bump on the back of the wrist. It will also likely be sensitive to the touch, and you may see swelling or even a fluid-filled cyst. The pain is usually described as burning or pulling, and it becomes significantly more painful when you use your hand and thumb. 

• Activities Which Aggravate The Pain

Tasks involving forceful gripping, pinching, or wrist twisting are highly provocative. Symptoms are triggered by everyday activities, including:

• Opening a jar
• Using scissors
• Typing on a keyboard
• Making a fist

A ‘Catching’ Sensation and Movement Difficulty

The other symptom that you can experience is a ‘catching’ or ‘snapping’ feeling when you move your thumb. This sensation arises when the distended tendons have a hard time entering the narrowed sheath and, as such, temporarily get entangled and then disengage. You could hear an audible squeaking or creaking sound, called crepitus, in certain instances, which is the direct consequence of the inflamed tissues rubbing together. 

The pain and swelling may cause noticeable stiffness as the condition advances, especially in the morning, and you may not be able to move your thumb and wrist freely. Such a functional limitation may disrupt your fine motor skills, including the ability to button a shirt or write with a pen.

These symptoms should be differentiated from other disorders, including carpal tunnel syndrome, which is characterized by numbness and tingling in the first three fingers, or arthritis, which is usually characterized by deeper joint pain and morning stiffness that goes away with motion. The identification of the particular pattern of pain and triggers related to De Quervain's is the initial step in the search for the appropriate diagnosis and effective treatment.

Major Causes and Risk Factors

De Quervain's tendinitis is basically an overuse injury that is caused by repetitive movements that overstretch the tendons of your thumb and wrist. Although sometimes a sudden trauma may cause the condition, the overwhelming majority of cases are acquired with time as a result of repeated micro-trauma that causes inflammation and thickening of the tendon sheath. 

Repetitive Strain from Work and Hobbies

Repetitive gripping, grasping, pinching, or wringing can also contribute to the development. For example, the following are some of the most popular activities that generate this mechanical stress:

• Leisure activities such as knitting and gardening
• Racket sports like tennis
• Prolonged video gaming
• Jobs that require extensive and vigorous hand activity, like carpentry, hairstyling, or assembly line jobs

The Effect of Modern Technology

Over the past few years, new risk factors have emerged due to the rise of handheld technology. The repetitive, high-speed thumb motions required to type and scroll smartphone screens have led to more diagnoses, commonly known as "texter's thumb" or "gamer's thumb." These actions cause your thumb to be in a long-term abducted and extended position, which directly puts strain on the abductor pollicis longus and extensor pollicis brevis tendons. These devices are usually designed in a way that does not accommodate the natural position of the hand and the wrist, which increases the pressure on these susceptible organs.

The 'Mommy Thumb' Phenomenon

New parents are also typical sufferers of the condition, which is known as "mommy thumb" or "baby wrist." The monotonous motion of picking up a baby or a toddler, scooping them with your wrists bent and your thumbs straight out to give you a grip, is a traditional trigger.

Such movement, repeated dozens of times a day, is a direct route to tendon irritation. New mothers are also especially vulnerable to swelling around the tendons due to hormonal changes and fluid retention related to pregnancy and the postpartum period. 

Key Demographic and Medical Factors

Women are statistically 8 to 10 times more likely to develop De Quervain's disease than men, with the highest incidence between 30 and 50. Although the cause of this gender difference is not fully understood, it is likely a combination of hormonal factors and biomechanical differences.

Lastly, predisposing factors can also include underlying inflammatory diseases such as rheumatoid arthritis, as inflammation can occur systemically and affect the synovial sheaths of your body, including those in your wrist.

The Diagnosis of De Quervain’s

Contrary to diseases that require advanced imaging, such as an MRI or X-ray, the diagnosis of De Quervain's disease can nearly always be made by a detailed clinical examination. 

Understanding Your Story During the Initial Consultation

The process focuses on understanding your experience and which anatomical structures are involved. The first step in your consultation will be an in-depth interview, during which your physical therapist will closely listen to you as you explain your symptoms, the onset of their occurrence, and the activities that either exacerbate or alleviate your pain.

Your physiotherapist shall inquire about your daily activities, work, interests, and whether you have experienced any changes in your level of activity. This knowledge will give the physiotherapist important background information, which will help us identify the repetitive actions that are likely irritating your tendons.

The Hands-On Physical Examination

After initial discussion, your therapist will conduct a special physical examination of your hand, wrist, and forearm. This practical examination enables the specialist to view the affected region firsthand. The physiotherapist will touch or feel the area around the base of your thumb and wrist to determine whether you have pain at that exact location and to examine for palpable swelling, warmth, or tenderness. 

An evaluation of the quality of the soft tissues of your forearm will also be performed, since tightness of the respective muscles may contribute to tensile forces on the affected tendons. Then, your therapist will take you through a set of active and passive range-of-motion tests to assess the mobility of the thumb and wrist joints and will note any movements that produce your pain or are accompanied by the typical sensation of snapping or catching.

Confirming the Diagnosis through The Finkelstein Test

The Finkelstein test is an orthopedic test used to guide the diagnostic evaluation of De Quervain's disease. To do this maneuver, your physical therapist will teach you to do the following:

• First of all, put your thumb in your palm
• Then close your other four fingers over your thumb and make a fist
• Lastly, bend your wrist slowly downwards towards your little finger (a movement referred to as ulnar deviation)

If this movement produces sharp, intense pain on the thumb side of your wrist, it is a strong positive sign of De Quervain tendinitis. The working principle of this test is that the inflamed abductor pollicis longus and extensor pollicis brevis tendons are stretched by the constriction of their sheath, thus causing the pain to recur. Your reported history, combined with the results of our physical examination and a positive Finkelstein test, allows us to diagnose you and begin creating a personalized and effective treatment plan.

Physical Therapy Treatment Plan for De Quervain's

Your physical therapist will create a complex treatment program tailored to you. They aim to treat your symptoms and the causes simultaneously. This is a holistic plan that integrates activity modification, manual therapy, and a progressive exercise program.

Custom Splinting and Activity Modification

Calming the inflamed tissues is the first and most crucial step in treating acute De Quervain tendinitis. To do this, the specialist must reduce the mechanical load on the affected tendons. The use of a splint or a thumb spica splint is likely to be recommended by your physical therapist to keep your wrist and the bottom of your thumb immobile. The splint allows the joints to rest in a neutral position without repetitive movements, which irritate the tendons and their sheaths, and provides the joints with uninterrupted time to heal.

The physiotherapist will ensure the splint is comfortable and fits you correctly. They will give you clear instructions on when to wear it and for how long, usually only during the first inflammatory phase, and then at night or during certain aggravating activities as the symptoms improve.

Activity modification, in addition to splinting, is necessary for successful recovery. You cannot always just quit all the activities that cause pain, particularly when taking care of a child or working. This is where your physical therapist's skill comes in handy. Rather than simply telling you what to avoid, we will sit down with you, examine your movement habits, and come up with other ways to complete daily tasks without straining your wrist so much. This is referred to as ergonomic training.

Manual Therapy and Pain Management

• Hands-On Manual Therapy Techniques

Although splinting and rest are essential for reducing irritation, physical therapy can be very helpful in speeding up your recovery and providing more immediate pain relief. This aspect of your treatment is called manual therapy. Your therapist can apply soft-tissue mobilization to the muscles in your forearm that move your thumb and wrist, using specific pressure and massage techniques. 

These muscles can also develop tightness and trigger points that can overstrain the tendons, which can cause inflammation. We can relieve the pulling on the tendons by releasing this tightness, thereby relieving pain and improving the smooth sliding of the tendons. We can also employ mild joint mobilization procedures to reestablish standard mechanics in the small carpal bones of your wrist in case there is any stiffness or limitation in your exam.

• Therapeutic Modalities for Pain Relief

Physical therapists use different modalities of treatment to control pain and inflammation, especially during the acute stage of your condition. These therapies are well chosen to deal with certain phases of your recovery:

1. Cryotherapy—ice packs are a straightforward yet effective method for reducing swelling in the painful area. Cold temperatures trigger vasoconstriction, which reduces blood flow to the inflamed tendon sheath and helps regulate the inflammatory response.
2. Thermotherapy—On the other hand, once the situation is no longer acute, we may also include heat therapy to enhance circulation, loosen tight muscles, and stimulate tissue regeneration.
3. High-Tech Modalities—Your physical therapist can also consider other modalities, such as ultrasound, which uses sound waves to generate deep heat that helps with healing, or electrical stimulation, which helps control your pain impulses.

These therapies are not mere passive therapies; they are well-chosen and implemented so that you can provide the best environment for your body to heal, and, as a result, the following therapeutic exercises will be more straightforward and more realistic. This combination will ensure that we treat your symptoms and the underlying tissue dysfunction on multiple fronts.

• Therapeutic Modalities for Pain Relief

1. Phase 1: Beginning with Gentle Mobility Exercises

When the initial pain and inflammation start to decrease, your physical therapist will present a well-thought-out and progressive exercise plan to you. This is the dynamic part of your rehabilitation, and it is essential for regaining full function and avoiding the recurrence of your symptoms. 

These exercises aim to increase the flexibility, strength, and endurance of the muscles and tendons around your wrist and thumb to meet the demands of your daily activities. We shall start with mild range-of-motion activities to overcome any stiffness that may have built up during splinting, as well as to stimulate the circulation of healing nutrients to the region. These can include slow flexion and extension of the wrist and movement of the thumb through its natural range of motion, always in a pain-free position.

2. Progressing to Tendon Gliding and Strengthening

At this point, your physiotherapist will move to a more advanced stage of rehabilitation: tendon gliding exercises. They are targeted, directed movements intended to pull the abductor pollicis longus and extensor pollicis brevis tendons in a gentle back-and-forth motion.

This sliding motion helps disrupt any minor scar tissue or adhesions that might have formed, allowing more effortless movement and preventing the tendons from becoming entangled. As you move better, your specialist will add strengthening exercises. Your program shall be well advanced and usually comprise the following:

1. Isometric Exercises—These are done initially; that is, you contract the muscles without moving the joint. For example, you can touch your thumb to a surface to stimulate the muscles without irritating them.
2. Isotonic Exercises—When you become stronger and the pain goes down, we will proceed to isotonic exercises with light resistance, for example, squeezing a soft ball or stretching a rubber band with your thumb.
3. Eccentric Exercises—Lastly, we will add eccentric exercises, which involve stretching the strained muscle, a method that is very effective in the rehabilitation of tendinopathies.

Prevention and Recovery Timeline

Your Physical Therapy Recovery Schedule

The recovery process following De Quervain tendinitis is not a quick fix and thus requires time and effort. It is still possible to make a big difference even with a specific physical therapy program. In the majority of cases, when treated early, symptoms begin to improve significantly within 4 to 6 weeks of regular therapy. In the meantime, you will slowly be able to get back on your feet, and the acute pain from gripping and twisting movements will be reduced. 

Your physical therapist will be keeping a close eye on your progress and will change your treatment plan as you transition out of the acute phase of pain management and into the strengthening and functional restoration phase. This is not only aimed at making you feel better but also at ensuring that your tendons and muscles are strong enough to support your day-to-day activities without reinjury.

Long-Term Prevention

It is equally essential to prevent the recurrence of the tendinitis that De Quervain first experienced as it is to treat the initial episode. Prevention is based on the main principles of avoiding chronic use and maintaining proper body mechanics. The following are some of the primary prevention measures that your therapist will assist you in incorporating into your life:

• Include Frequent Breaks. When your occupation or leisure activity requires you to use your hands repeatedly, it is essential to spend a couple of minutes after every hour to leave your work and do the simple wrist and thumb exercises that your therapist explained to you. This is a fundamental practice that can break the pattern of recurring strain, which causes inflammation.
• Apply Ergonomic Principles. Be attentive to your sitting and wrist position during typing, using tools, or lifting. Maintain the wrist in a straight, neutral position to reduce the tendon stress.
• Apply Less Risky Lifting. New parents are particularly interested in this. You should learn not to use your thumbs to provide leverage when lifting a child, but instead you should keep your wrists straight and place your hands under the body of the baby to spread the weight to your forearms.
• Optimize Your Workstation. An ergonomic evaluation can be extremely helpful to office workers. The wrong wrist positions that cause tendon strain can be avoided by ensuring your chair, desk, and keyboard are at the right height.

Locate a Physiotherapist Near Me

The persistent pain of the tendinitis of De Quervain should not dictate your life and deny you the pursuit of the activities that you enjoy. Although the pain may be severe, the condition is quite treatable, and recovery is possible. Physical therapy is a practical, evidence-based, and non-surgical way to go, which does not merely suppress your symptoms in the short run. 

Through the assistance of an experienced physical therapist, you are focusing on the causes of your pain, which are the mechanical strains, muscular imbalance, and movement patterns that caused the inflammation in the first place. This holistic method not only makes healing easier but also equips you with the information to prevent the problem from recurring.

Suarez Physical Therapy can help you start your path to living a pain-free life in Las Vegas. Call us at 702-368-6778.