QUESTION: A 30 year old female office worker has developed pain in her wrist since the birth of her first child. She is having trouble picking him up and writing.
What is it?
DeQuervain’s Syndrome is the irritation of the two tendons that insert at the base of the thumb as they pass through the extensor sheath. The extensor pollicis brevis and abductor pollicis longus muscles are responsible for lifting the thumb up and away from the palm. Repetitive movements of the thumb and wrist as well as activities requiring pinching can cause pain and swelling around the tendons. Aggravating activities may include holding a baby, writing, grasping bed sheets, pulling up trousers, turning keys, and carrying plates.
A hand therapist can assess you for DeQuervain’s Syndrome and determine what treatment option is best for you. An ultrasound can help confirm diagnosis.
Dequervain’s Syndrome can be treated in a splint which supports both the thumb and the wrist. The splint will help to immobilise the affected tendons reducing inflammation and pain. Splinting may be required for 4-6weeks. There are a range of different splinting options; your therapist can discuss which splint design is best for you depending on your functional demands. Your therapist will provide you with:
- Education about your condition and appropriate treatment
- Range of movement exercises for uninvolved joints
- A supportive splint to immobilise, protect and support you thumb and wrist. Waterproof options are available
- Activity modification to reduce flare ups when caring for baby
- Techniques to help reduce pain and inflammation
- Graduated exercises for range of motion, nerve gliding, and strengthening
Surgical review may be required if your symptoms are not settling. Sometimes a cortisone injection in combination with splinting can help. Your therapist can discuss this with you and your GP can arrange a referral to a hand surgeon if required.