Monday, September 24, 2012

De Quervain's tenosynovitis

de Quervain’s tenosynovitis is caused by an inflammation and swelling of the tendons of the abductor pollicis longus and extensor pollicis brevis at the level of the radial styloid process. This inflammation and swelling is usually the result of trauma to the tendon from repetitive twisting motions. If the inflammation and swelling becomes chronic, a thickening of the tendon sheath occurs with a resulting constriction of the sheath. A triggering phenomenon may result with the tendon catching within the sheath, causing the thumb to lock, or “trigger.” Arthritis and gout of the first metacarpal joint may also coexist with de Quervain’s tenosynovitis and exacerbate its pain and disability.

de Quervain’s tenosynovitis occurs in patients engaged in repetitive activities that include hand grasping, such as shaking hands by politicians, or high torque wrist turning, such as scooping ice cream at an ice cream parlor. de Quervain’s tenosynovitis may also develop without obvious antecedent trauma in the parturient.

The pain of de Quervain’s tenosynovitis is localized to the region of the radial styloid. It is constant and is made worse with active pinching activities of the thumb or ulnar deviation of the wrist. Patients will note the inability to hold a coffee cup or turn a screwdriver. Sleep disturbance is common.


On physical examination, there will be tenderness and swelling over the tendons and tendon sheaths along the distal radius with point tenderness over the radial styloid. Many patients with de Quervain’s tenosynovitis will exhibit a creaking sensation with flexion and extension of the thumb. Range of motion of the thumb may be decreased due to the pain, and a trigger thumb phenomenon may be noted. Patients with de Quervain’s tenosynovitis demonstrate a positive Finkelstein test. The Finkelstein test is performed by stabilizing the patient’s forearm and then having the patient fully flex his or her thumb into the palm and then actively forcing the wrist toward the ulna. Sudden severe pain is highly suggestive of d Quervain’s tenosynovitis.

Initial treatment of the pain and functional disability associated with de Quervain’s tenosynovitis should include a combination of the nonsteroidal anti-inflammatory drugs or cyclooxygenase-2 inhibitors and physical therapy. The local application of heat and cold may also be beneficial. Any repetitive activity that may exacerbate the patient’s symptomatology should be avoided. Nighttime splinting of the affected thumb may also help avoid the “trigger finger” phenomenon that can occur on awakening in many patients suffering for this condition. For patients who do not respond to these treatment modalities, the following injection technique may be a reasonable next step.

Injection of de Quervain’s tenosynovitis is carried out by placing the patient in a supine position, with the arm fully adducted at the patient’s side and the ulnar surface of the wrist and hand resting on a folded towel to relax the affected tendons.

The use of physical modalities including local heat as well as gentle range of motion exercises should be introduced several days after the patient undergoes this injection technique for elbow pain. A hand splint to immobilize the thumb may also help relieve the symptoms of de Quervain’s tenosynovitis. Vigorous exercises should be avoided because they will exacerbate the patient’s symptomatology. Simple analgesics and nonsteroidal anti-inflammatory drugs may be used concurrently with this injection technique. This injection technique is extremely effective in the treatment of pain secondary to the de Quervain’s tenosynovitis.

Low intensity laser therapy as well as a coordinated wellness program is also effective in treating this disorder.

Low Intensity Laser Therapy (LILT)

The low intensity Laser (LILT) sends photons (light) into the injured tissues and can penetrate two to three inches to treat affected areas. It uses a natural enhancement of the cellular machinery that can and has been dynamically measured in published studies to promote healing without burning affected tissue .Once the photons find the injured tissues, they stimulate and energize the cells to repair and strengthen at a remarkable rate. The treatment does not hurt, takes about 30 minutes and is very cost advantageous.

Wellness Program

A wellness program whichindividualizes treatment for age, performance and function has been shown in pilot studies to improve the overall health and well being of the individuals evaluated. A well conceived dietary and supplementary regimen based on scientific age–related decline in certain necessary compounds can improve quality of life, correct the ravages of hormone imbalance, balance critical neurotransmitter function without resorting to powerful drugs for depression that often have unfavorable side-effect profiles and restore vitality and youth in daily exercise routines. Furthermore, when wellness products are utilized with success, individuals often seek less costly interventions including unnecessary surgeries and narcotic options to treat pain. For more information go to
Title: De Quervain's tenosynovitis
Rating: 100% based on 99998 ratings. 5 user reviews.
Post by

Related articles :


Post a Comment

Copyright © 2016. About - Sitemap - Contact - Privacy