What is DeQuervain’s Tenosynovitis?
Tendons are strong, cordlike fibers that attach muscle to bone across a joint. Two tendons used to straighten or extend the thumb to the hand are called the abductor pollicis longus (APL) and the extensor pollicusbrevis (EPB) (Figure 1). These tendons run in a tunnel, called a retinaculum, along the radial (or thumb) side of the wrist. The retinaculum is lined with tenosynovium, a slippery substance allowing tendons to glide back and forth without friction. Inflammation of the tenosynovium is called tenosynovitis, and the associated swelling can hamper the gliding action of the tendons. DeQuervain’s tenosynovitis affects the tendons on the thumb side of the wrist, and repetitive motions such as grasping, pinching, squeezing or twisting may be the cause this inflammation.
Signs and Symptoms:
Similar to arthritis, DeQuervain’s tenosynovitis causes pain, aching, or swelling along the base of the thumb (Figure 2). Pinching, grasping or twisting of the wrist may be especially painful. The pain may travel up the forearm toward the elbow, and there may also be a “knot” on the base of the thumb. The thumb may “catch” when it is bent, similar to trigger thumb.
Conservative or non-surgical treatment for DeQuervain’s tenosynovitis may include restricting activities that aggravate the tendon of the thumb, wearing a supportive splint, anti-inflammatory medications, icing the area, and steroid injections to reduce inflammation (Figure 3).
If conservative treatment fails, surgery may be recommended. A small incision is made above the retinaculum. The top of this tunnel is then split so to allow more room for tendons to glide back and forth (Figure 4). Scar tissue forms between the split ends to repair the tunnel, thereby enlarging the space in which the tendons must move. A bulky dressing and splint will be placed after surgery for about 10 days while the tissues heal. Restriction of heavier activities may be necessary for 4 to 6 weeks following surgery.
Post Operative Rehabilitation:
- Expect a surgical bulky splint to be kept in place for 10-14 days.
- Elevate and ice for at least 3 days.
- Continue to elevate as often as possible until your next clinic visit. (Elevate above your heart.)
- Shower with a plastic bag covering the splint and seal with tape.
- Take your pain medicine as needed and as prescribed. Call if any problems or questions arise.
- Avoid activities that require sustained pinch in combination with ulnar deviation and/or palmar flexion of the wrist for 6 weeks.
10-14 Days Post Op (at therapy):
- Bulky dressing, splint, and sutures will be removed.
- Therapist will initiate edema management, scar massage, and manual desensitization exercises within 24 hours of suture removal as long as wound is fully healed.
- Gentle active Range of Motion (ROM) to the thumb and wrist is initiated, progressing to gentle passive ROM as wound heals and patient tolerance permits.
- Begin home exercise program.
- Therapist will issue new wrist splint with digits and thumb free to wear at all times except during exercises and showering for 3 weeks. (Usually this is a prefabricated splint, but there are times a custom splint will be made.)
4 Weeks Post Op:
- Follow up appointment in clinic with P.A. or M.D.
- Maximize passive ROM to the thumb and wrist per patient tolerance, continuing active ROM and emphasizing home exercise program.
- Initiate progressive strengthening to thumb and wrist.
- Continue edema management, scar management, and desensitization exercises as needed.
- Begin to wean from splint.
6-8 Weeks Post Op:
- Follow up appointment in clinic with M.D.
- Progressively return to normal use of the hand.
- May begin thumb flexion in combination with wrist flexion at 6 weeks.
- Use power grip position when possible (instead of using thumb) with work or sports activities.
- Work with the wrist in a neutral position.
- Incorporate more of the arm when turning screwdriver to distribute the overall force.