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DeQuervain's Tenosynovitis-Thumb and Wrist Pain

DeQuervain's Syndrome was first noted by a well known Swiss surgeon and professor while he was still a young man. Over his lifetime (May 4, 1868 - 1940), he published more than 300 papers.
Fritz De Quervain was a strong proponent of a general rather than specialist medicine. He was one of the earliest clinicians to identify embolism as a cause pulmonary infarction that was often diagnosed as pneumonia in recovering surgical patients. He identified and researched the syndrome that now bears his name in 1895.

De Quervain Syndrome is also known as gamer's thumb, washerwoman's sprain, mother's wrist, mommy thumb, hitchhiker's thumb, radial styloid tenosynovitis, de Quervain's tenosynovitis, de Quervain's stenosing tenosynovitis or DeQuervain's tendonitis. The more colorful names come from the actvities that seem to be causally realted. The more medical names are either descriptive (e.g. stenosing) or related to where it occurs (e.g. radial styloid).
Do not self-diagnose or self-prescribe splinting or treatment. There are other conditions that can mimic DeQuervain's Syndrome.

Symptoms

Whatever you call it, it's painful. Symptoms are

Structures Involved

There are two small tendons in what is called the first dorsal compartment of the wrist running to the extensor pollicis brevis and abductor pollicis longus muscles. These two muscles control thumb movment away from the palm into what may be considered the hitchhiker position. You can also get your thumb into this position by placing your hand palm side down on a table and sliding your thumb away from the side of your hand. They pull the thumb out and back (abduction), not toward and in.

The tendons are wrapped in synovial sheaths (thus tenosynovities) and run in the first extensor compartment through the wrist. Their angle allows the muscles to pull the thumb into position by becoming shorter.

Actual cause of DeQuervain's is not known but it has been linked to tendon overuse and to obstruction within the compartment such as a bony growth that impedes the smooth movement of the tendons within their narrow pathways.

Solutions?


Neutral position (position of least stress) is essentially a relaxed hitchhiker position - with the thumb curving slightly toward the palm but still held away from the side of the hand. This means some stress is placed on the structures with anything you do with your thumb moving it out of the relaxed hitchhiker position. The hand is frequently splinted into this position. An IMAK Thumb Spica splint is pictured, but splints can vary in length of arm coverage, rigidity, etc depending on judgement of the prescriber.

There is evidence that cortisone injections help, but results are inconsistent with between 56% and 74% showing good results. If your pain is severe, these are fairly good odds. Be sure to find out about potential adverse effects before you have the injection. Generally these are only problematic with excessive application. TENS is sometimes helpful in reducing inflamation, thus increasing comfort.

There is not a lot of scientific evidence that anything except rest, anti-inflamatories, cortisone and perhaps surgery are useful in addressing the problem. Gentle exercise can assist in maintaining range of motion and muscle flexibility, but must be judiciously applied. I could not find studies on other therapeutic modalities linked specifically to DeQuervain's.

General pain control measures such as cold packs are useful in maintaining comfort and allowing some activity.
While you are healing You many find the Comfort Cold Thumb Support helpful during your rest time. This is a sample of the Comfort Cool Thumb Support available at Amazon.com. Another option that many love is a portable hot/cold pack that maintains flexibility when cold and holds cold or warmth up to 60 minutes.

The cold will help to reduce inflamation, especially if you can keep it applied over a period of 20 minutes. Unlike ice and cold water, these splints in particular allow you to move around and have some function while using cold. The cold packs allow you some mobility, but less function. Do not use cold treatments while you are working as this inibits the muscle's ability to react to use appropriately.

REFERENCES
Grey's Anatomy of the Human Body: http://www.bartleby.com/107/
DeQuervain's Tenosynovitis:www.mayoclinic.com/health/de-quervains-tenosynovitis/DS00692/
Fritz De Quervain: en.wikipedia.org/wiki/De_Quervain_syndrome

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