De Quervain’s Disease And Physiotherapy Treatment :

INTRODUCTION:-
→ De Quervain disease also known as BlackBerry thumb, texting thumb, gamer’s thumb, washerwoman’s sprain, radial styloid tenosynovitis, de Quervain syndrome, de Quervain’s tenosynovitis, de Quervain’s stenosing tenosynovitis, mother’s wrist, or mommy thumb
→ The DQ is a tenosynovitis of the sheath or tunnel that surrounds two tendons that control movement of the thumb.

de_Quervains disease

               De_Quervains disease

ANATOMY:-
→ Tendons are rope-like structures that attach muscle to bone.
→ When you grip, grasp, clench, pinch or wring anything in your hand, two tendons in your wrist and lower thumb normally glide smoothly through the small tunnel that connects them to the base of the thumb. Repeating a particular motion day after day may irritate the sheath around the two tendons, causing thickening and swelling that restricts their movement

SIGNS AND SYMPTOMS :-
→ Pain near the base of your thumb.
→ Swelling near the base of your thumb.
→ Difficulty moving your thumb and wrist when you’re doing something that involves grasping or pinching.
→ A “sticking” or “stop-and-go” sensation in your thumb when moving it.

CAUSES:-
→ Chronic overuse of your wrist is commonly associated with de Quervain’s Disease.
→ Other causes included – Direct injury to your wrist or tendon; scar tissue can restrict movement of the tendons,  Inflammatory arthritis, such as rheumatoid arthritis.

RISK FACTORS:-
→ Age – If you’re between the ages of 30 and 50, you have a higher risk of developing de Quervain’s disease than do other age groups, including children.
→ Sex – The condition is more common in women.
→ Being pregnant – The condition may be associated with pregnancy.
→ Baby care – Lifting your child repeatedly involves using your thumbs as leverage and may also be associated with the condition.
→ Jobs or hobbies that involve repetitive hand and wrist motions – These may contribute to de Quervain’s tenosynovitis.

DIAGNOSIS:-
De Quervain disease is diagnosed clinically, based on history and physical examination, though diagnostic imaging such as x-ray may be used to rule out fracture, arthritis, or other causes, based on the patient’s history and presentation.
→ Finkelstein’s test is a physical exam maneuver used to diagnose de Quervain disease. To perform the test, the examiner grasps the thumb and sharply deviates the hand toward the ulnar side. If sharp pain occurs along the distal radius (top of forearm, about an inch below the wrist), de Quervain’s syndrome is likely. While a positive →Finkelstein’s test is often considered pathognomonic for de Quervain syndrome, the maneuver can also cause pain in those with osteoarthritis at the base of the thumb.

Finkelstein's test

Finkelstein’s test

TREATMENT:-
→ Medication – To reduce pain and swelling -ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve).

→ corticosteroid injection was the first line of treatment and surgery should be reserved for unsuccessful    injections,  most people recover completely after receiving corticosteroid injections, often after just one injection.

PHYSIOTHERAPY TREATMENT:-

→ Immobilizing your thumb and wrist, keeping them straight with a splint or brace to help rest your tendons
→ Avoiding repetitive thumb movements as much as possible
→ Avoiding pinching with your thumb when moving your wrist from side to side
→ Applying ice to the affected area.
→ Applying tapping in thumb.

tapping in thumb.

                                     tapping in thumb

Thumb Splint

                       Thumb Splint

You may do these exercises when it is not painful to move your hand.
→ Opposition stretch: Rest your hand on a table, palm up. Touch the tip of your thumb to the tip of your little finger. Hold this position for 6 seconds and then release. Repeat 10 times.
→ Wrist stretch: Press the back of the hand on your injured side with your other hand to help bend your wrist. Hold for 15 to 30 seconds. Next, stretch the hand back by pressing the fingers in a backward direction. Hold for 15 to 30 seconds. Keep the arm on your injured side straight during this exercise. Do 3 sets.
→ Wrist flexion: Hold a can or hammer handle in your hand with your palm facing up. Bend your wrist upward. Slowly lower the weight and return to the starting position. Do 2 sets of 15. Gradually increase the weight of the can or weight you are holding.
→ Wrist radial deviation strengthening: Put your wrist in the sideways position with your thumb up. Hold a can of soup or a hammer handle and gently bend your wrist up, with the thumb reaching toward the ceiling. Slowly lower to the starting position. Do not move your forearm throughout this exercise. Do 2 sets of 15.
→ Wrist extension: Hold a soup can or hammer handle in your hand with your palm facing down. Slowly bend your wrist up. Slowly lower the weight down into the starting position. Do 2 sets of 15. Gradually increase the weight of the object you are holding.

Wrist Movement

Wrist Movement

→ Grip strengthening: Squeeze a soft rubber ball and hold the squeeze for 5 seconds. Do 2 sets of 15.

Grip Strengthning

                  Grip Strengthening

Grip Strengthning

           Grip Strengthning

Grip Strengthning

              Grip Strengthning

→ Finger spring: Place a large rubber band around the outside of your thumb and fingers. Open your fingers to stretch the rubber band. Do 2 sets of 15.

Finger spring

             Finger spring

 

 

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