One of the most common overuse injuries of the wrist and hand is DeQuervain's Tenosynovitis. DeQuervain's is most common among women between 30 and 50 years old, but it can affect anyone. Although repetitive grasping activities, especially while tilting the wrist or using the wrist sideways, can irritate the tendons on the side of your thumb, more often than not, there is no clear cause of your trouble.
The tendons which operate the thumb are contained in a fluid-filled sheath. For whatever reason, this sheath becomes swollen and inflamed. The body, trying to solve the problem, starts to lay down scar tissue to stabilize the painful tissue. The scarring causes the tendon and the sheath to stick and pull on each other causing you more pain.
DeQuervain's Tenosynovitis causes pain over the thumb side of the wrist in an area called the anatomical snuff box. If you feel your wrist just below the thumb joint at the base of your palm, you'll feel a little hollow area. This is the anatomical snuff box and it holds three tendons which can be the source of your trouble. Rest the fingers of your other hand lightly here and you may be able to feel the tendons snagging on the scar tissue causing a gritty or grinding sensation as you move your thumb.
Pain from DeQuervain's may have come on gradually or may seem to have started overnight. The pain may travel up the thumb to the forearm and gets worse especially with forceful use of the wrist. There may be swelling over the thumb side of the wrist. Thumb movement is painful and you find yourself avoiding gripping activities.
The Finkelstein's test (presumably named for the person who devised the test) is very uncomfortable, even painful, for folks suffering with DeQuervain's Tenosynovitis. Close your thumb inside your fist and tilt your wrist directly away from your thumb. I bet you just did that, didn't you? Discomfort during this test does not mean you have DeQuervain's, but when you combine this test with other symptoms, the implication is clear.
You can try treating your symptoms at home. Make little ice cups out of those tiny Dixie cups. Peel back the edge of the paper cup and spend five to seven minutes massaging the painful area with the ice. The area should be quite red and numb when you get done. Put a little lotion on your fingers and rub the painful area. See if you can feel areas that seem tight and roll the tissue around between your fingers to loosen it. You can buy a spica splint at most pharmacies. This is an odd looking brace which not only fully encompasses your thumb holding it out away from your palm, but also holds your wrist still. An ordinary wrist splint, like those worn for a wrist sprain, will not work. The thumb needs to be immobilized.
If you have worn your brace and done your treatment at home for 10 days and aren't any better, it's time to see your doctor. It is important to rule out other possible causes of your thumb pain. The thumb joints near the wrist are prone to developing instability and arthritis so your doctor may order an x-ray of your hand.
Physical therapy is quite helpful for DeQuervain's. We will use a number of treatments including manual therapy and a treatment called iontophoresis which delivers steroid medication to the painful area reducing the swelling and inflammation in those tissues.
If all this fails, your doctor may decide you need a steroid injection. DeQuervain's doesn't often, but does occasionally require surgery. It's a simple surgery and the recovery from it isn't bad. Like any surgery, it has its risks, though, so don't go jumping onto the operating table.
If you think you have DeQuervain's Tenosynovitis, you can try treating it yourself with ice packs and over the counter anti-inflammatory medication. Avoid doing things that hurt and rest your hand as often as possible. Don't put off treatment too long, though. The longer you have had this painful condition, the longer it will take to heal.
ABOUT THE WRITER:
Jackie Randa is a physical therapist who owns Back on Track in Barstow. She can be contacted at firstname.lastname@example.org