De Quervain tenosynovitis

All About DeQuervain’s Tenosynovitis

There are two stages of the treatment for De Quervain’s syndrome or De Quervains tenosynovitis. It is a painful condition affecting the tendons on the thumb side of your wrist. In case of acute stage, when there is inflammation the goal is reduction in inflammation and preserving movements. Subsequently, once the inflammation subsides the goal is improvement in function.

Acute stage treatment

  • Splint to support the thumb and the wrist and which provides support and helps healing procedure.
  • Help identify aggravating activities and suggest alternative postures
  • Cryotherapy (e.g.: cold packs, ice massage) to reduce the inflammation and edema
  • Therapeutic Ultrasound (i.e. phonophoresis) or electrically charged ions (i.e. iontophoresis)-Ways in which a medication can be driven into the soft tissues through skin and promote faster healing.
  • Plan and suggest activity modifications to correct abnormal position of the hand in a particular activity.
  • Corrective exercises: Help in maintain the correct postures of the hand and thus enable better healing, promote faster rehab and aid in the prevention of further complications.

Second stage treatment (once inflammation subsides):

The goal is to work on the range of motion, Flexibility, Strengthening, Preventing recurrence

  • Thermal modalities to promote and aid in healing.
  • Transverse friction massage to break the adhesions.
  • Therapeutic exercises – starting with Range Of Motion (ROM) exercises, and as the patient progresses, adding strengthening exercises
  • Ergonomic workstation assessment as needed (Design work place to prevent further injuries after assessment of the same)
  • Educating the patient to either avoid or decrease repetitive hand motions, such as pinching, wringing, turning, twisting or grasping..
  • Rehabilitation exercises to prevent recurrence.
  • A home-exercise program for the maintenance of the goals achieved by the physical therapist and hence aid in faster recovery of function..

Physiotherapy treatment DeQuervains

Ultrasound therapy for wrist

 

Exercises for wrist and thumb rehabilitation
 

What is deQuervain’s Syndrome ?

It is the tenosynovitis (inflammation of the fluid-filled sheath called the synovium that surrounds a tendon and helps them glide easily) of the two tendons that control movement of the thumb. Inflammation results in pain, swelling and constricted movement of the tendons within the tunnel on the side of your wrist (Base of thumb). The swollen tendons and their coverings rub against the narrow tunnel through which they pass. The result is pain at the base of the thumb. At first, the only sign of trouble may be soreness on the thumb side of the forearm, near the wrist. If the problem isn’t treated, pain may spread up the forearm or further down into the wrist or both and thumb and limit your range of motion. As the friction increases, the two tendons may actually begin to squeak as they move through the constricted tunnel. This noise is called crepitus. It is pai nful especially when you turn your wrist, grasp anything or make fist..

 

Wrist Pain

Wrist Pain on movement

 

 

What causes deQuervains ?

de Quervain’s tenosynovitis is basically a combination of overuse, repetitive movements e.g.; racket sports, hammering and poor hand on wrist posture. It can be idiopathic (has no specific cause).

Common causes include:

  • Repeated hand and thumb motions such as grasping, pinching, squeezing, or wringing may lead to the inflammation of tenosynovium.
  • Holding your hand at an angle to your wrist creates a compression point that excessively rubs the tendon.
  • This inflammation can lead to swelling, which restricts the smooth gliding action of the tendons within the tunnel.
  • Scar tissue from a previous injury can make it difficult for the tendons to slide easily through the tunnel.
  • Arthritic diseases that affect the whole body, such as rheumatoid arthritis, can also cause tenosynovitis in the thumb.
  • Arthritic diseases that affect the whole body, such as rheumatoid arthritis, can also cause tenosynovitis in the thumb.

 

Wrist injury

Text Thumb

Benefits of physiotherapy:

  • Physiotherapy treatment reduces inflammation and accelerates healing.
  • improve strength, range of motion and endurance and correct postural and muscle imbalance which in turn prevents recurrence of condition.
  • Ergonomic corrections and activity modifications prevent various other injuries of hand and wrist along with deQuervains.
  • Physiotherapy rehabilitation exercises helps to restart all activities early.
  • Recovery is rapid if you start treatment in early stages. Chronic condition takes time as lot of changes like adhesion formations, Muscle weakness take place. But one can expect full recovery with the rehabilitation program completion.

INTERESTING FACTS

Pregnant ladies and post-delivery mothers are affected more often. Contributory factors may include hormonal changes, fluid retention and – more debatably – lifting (baby).

carpal tunnel syndrome

Carpal Tunnel Syndrome

Early diagnosis and treatment is important in order to avoid any kind of permanent damage to the wrist nerve. As they say, prevention is better than cure, one should take care of their wrist positions while working. Alteration of activities is important. This includes taking frequent breaks from repetitive activities, and stretching before and after activities. A therapist may be helpful in reviewing ergonomic tips or performing a work place evaluation. For people with mild CTS, stopping or doing less of a repetitive movement may be all that is needed. Physiotherapy is often recommended as part of your treatment plan to reduce the pain, swelling and help in stretching the muscles and retinaculum around and strengthening them. A good physiotherapy program would include Navi Mumbai and Thane.

Physiotherapy is often recommended as part of your treatment plan to reduce the pain, swelling and help in stretching the muscles and retinaculum around and strengthening them. A good physiotherapy program would include

  • Carpal bone mobilization and flexor retinaculum stretching to open the carpal tunnel
  • Nerve and tendon gliding exercises to ensure full unrestricted nerve motion is available.
  • Muscle and soft tissue extensibility.
  • Comprehensive upper limb, wrist and hand ROM strengthening and endurance exercises.
  • Grip and pinch, thumb and forearm muscle strengthening in later phases.

A wrist splint can be worn to support and brace your wrist in a neutral position so that the nerves and tendons can recover. Splinting can work the best when done within three months of having any symptoms of CTS.

Generally, surgery is only an option for severe cases of CTS and if the other treatments have failed for a period of at least six months.

 

Ergonomics for carpal tunnel syndrome

Physiotherapy at Reliva involves three main components -: passive treatments, active treatments and education and self management. Passive treatments like heat/cold packs and electrotherapy (Ultrasound, TENS) are used to decrease acute pain and swelling. If you're experiencing acute pain, you'll most likely start with passive treatments as your body heals and/or adjusts to the pain. However, our goal is to take you towards active treatments which are therapeutic exercises including nerve gliding and stretching exercises with the strengthening of the muscles around prescribed in accordance with your overall condition and with changing dosage as you become stronger.

We also spend time in educating you about your condition, home exercises and dos and dont's, so that you can continue to remain healthy at your home even after the treatment is complete.

exercises for carpal tunnel syndrome

ReLiva physiotherapist will help you to:

 

  • Quickly relieve pain and swelling
  • Nerve gliding exercises
  • Loosen stiff muscles and ligaments
  • Strengthen your wrist and hand muscles
  • Improve your everyday living

What is carpel tunnel syndrome?

Our wrist is made up of eight small bones. A ligament (also called retinaculum) lies across the front of the wrist. Between this ligament and the carpal bones is a space called the carpal tunnel. This carpel tunnel is a cramped up space, crowded with the muscle tendons attaching the forearm and the fingers and a median nerve.

The median nerve gives sensation to the thumb, index and middle fingers, and half of the ring finger. It also controls the movement of the small muscles at the base of the thumb.

Any tension in this canal due to various reasons can compress the median nerve giving rise to the symptoms. This is known as Carpal tunnel syndrome (CTS).

The main symptoms are pain, burning sensation, numbness and tingling in the thumb, index finger, middle finger, and the thumb side of the ring finger. Pain may extend up the arm. Weak grip strength may occur and after a long period of time the muscles at the base of the thumb may waste away.

Typically, burning, acing, tingling sensations in the hand are present in the night. It is relieved by shaking or massaging the wrist.

 

carpel tunnel             carpel tunnel syndrome

 

What causes carpel tunnel syndrome ?

As stated above, the symptoms occurring in carpel tunnel is due to the nerve compression leading to inflammation. This in turn produces pain, swelling and at times obstructed blood flow. Causes of carpal tunnel syndrome are:

Congenital: the carpal tunnel is simply smaller in some people than in others

  • Obesity
  • Rheumatoid
  • Repetitive movements: repeated use of vibrating hand tools; poor positioning of the wrists while using keyboards, mouse; repeated movements at the wrist such as playing piano, typing
  • Development of a cyst or tumor in the canal.
  • Diabetes
  • Thyroid dysfunction
  • Fluid retention from pregnancy or menopause
  • High blood pressure
  • Fractures or trauma to the wrist

    Something you may not know:

    Women are three times more likely to have CTS than men. It may be that the wrist bones are naturally smaller in most women, creating a tighter space through which the nerve passes. Women also deal with strong hormonal changes during pregnancy and menopause that makes them more likely to suffer from CTS.

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