Have you been experiencing pain and tenderness at the base of your thumb, on the thumb side of your wrist, or along the thumb side of your forearm? If the answer is “yes,” you may be experiencing a type of tendinitis called DeQuervain’s tendinitis. Pain is made worse by grasping or extending the thumb (as if hitchhiking), and can affect individuals of all ages. Symptoms generally occur when the tendons are strained due to prolonged or repetitive use of the hand, rapid or forceful use of the hand, or use of the arm or hand in an awkward position. Fortunately, Physical Therapy can help relieve discomfort and irritation of the tendons, which can include manual therapy, range of motion and strengthening exercises, and in some cases splinting may be necessary. Common treatments often include cortisone shots by doctors, which is what we try to avoid with Physical Therapy treatment.
Who is at risk for developing DeQuevain's tendinitis?
Risk factors for developing DeQuervain’s tendinitis include:
Excessive use of the thumb from texting and gaming
Using the hand or arm in a position that feels awkward
Participation in sports that stress gripping, such as golf or tennis
Age greater than 40 years
Being female (women are 8 to 10 times more likely to develop this condition than men)
Pregnancy
What does DeQuervain's tendinitis feel like?
Individuals who are experiencing symptoms of DeQuervain’s tendinitis may:
Have difficulty pinching or grasping with the thumb or hand
Feel pain and/or swelling at the wrist near where the thumb attaches
Feel pain when moving the wrist from side-to-side or twisting it
Experience decreased range of motion and a feeling of weakness in the thumb
Have difficulty bending the thumb
Experience a “snapping” or “catching” sensation with movement of the thumb (not as common a symptom)
Pain with active use of the hand such as writing, opening jars, hammering, lifting a child, sports, or any home or workplace activity that involves pinching or grasping with the thumb
How Can physical therapy help for someone experiencing thumb pain from DeQuervain's tendinitis?
First and foremost, your Physical Therapist will perform a comprehensive evaluation to determine if your symptoms are truly due to DeQuervain’s tendinitis or due to an underlying condition that can mimic DeQuervain’s symptoms. This evaluation will include questions pertaining to how and when you first experienced symptoms, what makes it better or worse, and how it feels at the present time. A physical exam will include measuring range of motion of the thumb and wrist, strength testing of the forearm, wrist, and thumb, including grip strength, feeling for tender spots, and performing special tests such as a Finkelstein’s test, which gently stretches the tendons on the thumb side of the wrist where they pass through the extensor tunnel. Pain during this test is very common with DeQuervain’s tendinitis.
After diagnosing your condition as DeQuervain’s tendinitis, your Physical Therapist will work with you to develop an individualized treatment plan based on your specific condition. The primary goal early on will be to reduce pain and inflammation. A splint may be provided to position your wrist and thumb for rest. Manual therapy should be incorporated to assist with pain relief and improved range of motion. Therapeutic exercises will be prescribed to improve mobility and prevent stiffness. Early on the exercises will be restricted to avoid aggravating the condition. As symptoms diminish and pain free use of the hand/thumb starts to return, exercises will be progressed to increase strength for functional activity in addition to improving active range of motion of the wrist and thumb.
Your Physical Therapist should review and evaluate how you use your wrist, hand, and thumb for functional activities and will attempt to identify your activities or positions that may be contributing to the problem. This should include your normal daily activities as well as work and sports activities. They should also instruct you in how to make changes in your function to promote healing and prevent future reoccurrence. Specific instructions may be to avoid repetitive thumb and/or wrist movements, avoid bending the thumb, and avoid moving the thumb toward the little finger as much as possible. Forceful hand movements should be avoided, as should any movements or activities that cause pain.
Can This Condition Be Prevented?
It may certainly be possible to prevent DeQuervain’s tendinitis. Will some risk factors can obviously not be controlled, such as gender or age, Physical Therapists recommend that you:
Avoid excessive use of the thumbs for gaming and texting
Avoid putting the wrist and hand in awkward positions while using the arm or hand
Avoid chronic overuse of the hand
Avoid/restrict overly forceful use of the wrist
Train and condition in sports requiring gripping, such as golf or tennis, to minimize wrist/thumb strain
If you or someone you know is experiencing symptoms that you may think are being caused by DeQuervain’s tendinitis, don’t wait to take action. Call my office at once at (302) 691-9055 or visit my website at www.wildermanpt.com to schedule your FREE 30 minute consultation to see how Physical Therapy can help. Don’t wait–schedule now!