De Quervain’s Tenosynovitis

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De Quervain’s Tenosynovitis

De Quervain’s Tenosynovitis

WHAT IS De QUERVAIN’S TENOSYNOVITIS?

De Quervain’s tenosynovitis is a painful condition affecting the tendons in the first dorsal compartment of the wrist. The abductor pollicis longus and extensor pollicis brevis tendons as well as the synovium and tendon sheath become inflamed. The tendon then does not glide as smoothly in the sheath because of the increased friction and pain. This can cause a feeling of sticking, swelling, weakness and pain. De Quervain’s tenosynovitis can be aggravated or caused by repetitive motions, inflammatory arthritis  and severely limit a person’s ability to perform activities of daily living (ADLs).

SCREENING

De Quervain’s is most common in adult women. Those who are pregnant or caring for a small child or have rheumatoid arthritis are most at risk. Other risk factors include jobs and hobbies with repetitive hand movements.

Finkelstein’s test:

How to- passively pull thumb into flexion (ulnar deviation) and longitudinal traction

Eichhoff’s test: 

How to- fist around the thumb with neutral wrist position followed by ulnar deviation. A positive test is pain on the thumb side of the wrist.

Validity- Sensitivity: 0.89, Specificity: 0.14,

Wrist Hyperflexion and Abduction of the Thumb (WHAT) test: 

How to- Wrist flexion, thumb abduction, metacarpophalangeal and interphalangeal extension, followed by resisted thumb abduction/extension

Validity- Sensitivity: 0.99 Specificity: 0.29

DIFFERENTIAL DIAGNOSES

  • Tennis Elbow (lateral epicondylitis)
  • Arthritis
  • Carpometacarpal pathology
  • Cervical Radiculopathy
  • Median or Radial nerve pathology
  • Carpal tunnel syndrome
  • Scaphoid fracture
  • Intersection syndrome

WHAT CAN A PHYSIOTHERAPIST DO?

  • Determine useful stretches and exercises.
  • Review repetitive movements and provide suggestions to limit strain on these tendons.
  • Recommend a suitable splint if indicated.
  • Help reduce pain and swelling.
  • Determine if treatments are working. 

 

References: 

Goubau, J.F., Goubau, L., Van Tongel, A., VanHoonacker, P., Kerckhove, D., Berghs, B. (2014). The wrist hyperflexion and abduction of the thumb (WHAT) test: a more specific and sensitive test to diagnose de Quervain tenosynovitis than the Eichhoff’s Test. Journal of Hand Surgery; 39 (3): 286-92.

Magee, D.J. & Sueki, D. (2011). Orthopedic physical assessment atlas and video: Selected tests and movements. Elsevier Saunders.