Background & Etiology
A tendon is part of the muscle that attaches the muscle to bone. It is a strong, fibrous tissue that is responsible for transferring the forces generated by the muscle to the bone, thus producing movement at the joint. When a tendon becomes irritated or inflamed it becomes painful, especially with movement. Inflammation of the tendon is called tendinitis.
DeQuervain’s Tendinitis refers to the irritation and constriction of the tendons around the base of the thumb, including the abductor pollicis longus and the extensor pollicis brevis tendons. Irritation of the tendons on the thumb-side of the hand can cause the synovium (the sheath that surrounds the tendon) to become inflamed. This makes it difficult for the tendons to move properly, putting pressure on the nerves in the hand, which can cause pain and restricted movement.
DeQuervain’s Tendinitis occurs most often in middle-aged women, but can be related to rheumatoid arthritis, overuse, or pregnancy. Common causes of DeQuervain’s Tendinitis include:
- Participating in forceful thumb abduction and ulnar deviation activities such as opening jars, wringing hands, cutting with scissors, playing piano, and sewing that can strain the hand.
- Repetitive strain injuries (RSI) at work occur in people who have jobs that require performing activities of a repetitive and/or forceful nature, that require holding the hand and fingers in the same position, for example typing on a keyboard.
- Sudden trauma or an accident like a fall where an individual puts their hands down to catch themselves, putting pressure on their wrist and hand.
- Patients with inflammatory conditions, like rheumatoid or osteoarthritis, may be susceptible to tendinitis
- Pain or tenderness directly over the tendon that can radiate to the hand, and wrist or forearm
- Pain or burning sensation during activities that use the hand
- Difficulty dressing and performing activities of daily living
- Weakness may occur as the inflammation gets worse
- Feeling of tightness or loss of motion due to discomfort
- Swelling of the tendon
If an individual suspects they have a tendinitis, the initial treatment should consist of avoiding the positions and activities that produce the pain. A course of conservative treatment is usually recommended that would include rest and immobilization, ice, hand therapy and non-steroidal medications to reduce inflammation. If symptoms persist, treatment by your physician may be necessary. This may include steroidal medication or injections, in conjunction with therapy. In severe cases surgical intervention may be needed to correct any mechanical causes of the tendon irritation.
Hand Therapy Interventions
Hand Therapists are occupational therapists or physical therapists who, through advanced study and experience, specializes in treating individuals with conditions affecting the hands and upper extremity. A hand specialist may also have advanced certification as a Certified Hand Therapist (CHT). A qualified hand therapist is educated and trained to administer interventions. As stated in The Guide to Physical Therapist Practice, interventions are the skilled and purposeful use of therapy methods and techniques to produce changes consistent with the diagnosis, prognosis and goal of the patient or client. Common interventions in the treatment of DeQuervain’s Tendinitis include:
- Manual Therapeutic Technique (MTT): hands on care including soft tissue massage and passive stretching by a hand therapist to regain mobility and range of motion of the hand and tendon.
- Splinting: Fabrication of custom-made splint or fitting of pre-fabricated splint to limit thumb motion and decrease inflammation.
- Therapeutic Exercises (TE) including stretching and gliding exercises to regain range of motion and strengthen the hand and effected muscle.
- Neuromuscular Reeducation (NMR) to restore stability and improve movement technique, including activity modification to minimize ulnar deviation and pinching in daily use of the involved upper extremity, and sensory stimulation techniques to decrease tenderness.
- Modalities that can include the use of ultrasound, paraffin, electrical stimulation, ice, cold laser and others to decrease pain and inflammation at the hand and tendon.
- Home program that includes splinting, stretching and stabilization exercises and instructions to help the person perform daily tasks and advance to the next functional level.
Procedures that your physician may recommend and perform in addition to physical therapy that include:
- REST and ICE
- The use of NSAIDS (Non Steroidal Anti-Inflammatory Drugs)
- Steroidal injections to reduce inflammation
- Pain medication to reduce the discomfort and allow the patient to perform the recommended exercises
- Surgery to correct underlying pathology or the cause of the tendinitis
Most people recover full function following a course of conservative care that includes hand therapy, medication and/or injections. It is important that once the pain and inflammation is reduced, and motion and strength are restored, the patient gradually returns to full activities. Instruction in daily activities or sport performance is helpful for reducing a reoccurrence of tendinitis.