Is the back of your thumb sore? Does it hurt every time you grip an object or go to write something down? Does it feel like a sharp pain when you use it and throb later on at rest? If so, you could be dealing with the most common form on tendonitis in the hand — DeQuervain's Tenosynovitis.
DeQuervain, a Swiss surgeon and anatomist who practiced medicine in the late 19th century, noticed that people frequently had pain along the backside of the thumb and wrist. There are two tendons in this area that run together that help to cause movement of the thumb, and often become inflamed and painful if placed under too much strain.
These tendons run together inside of a structure known as a tendon sheath. With excessive or repetitive use, these tendons rub together causing inflammation and also release of other chemicals that cause pain and limit tolerance to all activities involving the hand. Most tendons have their own sheath to minimize this rubbing effect. This explains why tendonitis of the thumb in this location is so common.
Those most commonly affected by DeQuervains are people who have a repetitive type job such as toll takers, laborers and professions that use a lot of fine gripping like dentists and wood-workers. Those also prone to acquire it are people that write a lot, like teachers and office assistants.
People that have DeQuervain's should avoid activities that involve a lot of griping and twisting of the hand and wrist. Activities like knitting and tennis should be avoided until the pain and inflammation is under control. Even little things like gripping the steering wheel and typing may need to be modified to speed up recovery.
There are a number of treatment options available for people with DeQuervain's Tenonsynovitis. The most frequently used treatment protocol involves a series of stretching and strengthening exercises combined with patient education and modalities to reduce inflammation. This course is successful in over eighty percent of the cases seen in a physical therapy clinic.
For patients that do not respond to initial conservative management, a custom-made brace can be fabricated that will help to limit motion of the thumb. This brace will prevent the tendons from being over stretched and irritated.
In the event that conservative management fails, surgery is an option. Because of the long rehabilitation time and postoperative pain, it is strongly recommended that patients exhaust all non-surgical options including therapy, bracing and cortisone injections prior to undergoing surgery. There are a number of surgical procedures that involve decompressing the tendons in the sheath, and the prognosis with surgery is very good if the postoperative protocol is followed.
DeQuervain's Tenosynovitis is a common and curable problem encountered by most physical therapists daily. If your thumb and wrist are hurting, see a pysical therapist soon — they'll help you get a grip on the problem.
Joe DiVincenzo is a physical therapist and clinical specialist in manual therapy. He works in the outpatient division of Beverly Hospital and writes "On the Mend" weekly. Questions may be submitted to Joe by email: joedivincenzo@comcast.net.
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