SUNBURY PHYSIOTHERAPY

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What is De Quervain’s Tenosynovitis?

De Quervain’s Tenosynovitis is a painful condition that affects two tendons on the thumb-side of the wrist. These tendons are responsible for moving the thumb sideways and backwards and sometimes become trapped as they pass through a small tunnel between the wrist and the thumb.

These tendons respond poorly to the extra compression and become sore to move and tender to touch. In some circumstances, the thickened, inflamed tissues may develop adhesions, or scarring, restricting movement of the thumb.

This condition affects many people, typically between the ages of 30 and 50. Women are affected 10 times more than men. Those affected include sportspeople who use rackets, bowlers, rowers, golfers, and canoeists. Manual labourers who perform repetitive duties are also commonly affected. De Quervain’s tenosynovitis is caused by a combination of overuse and overload factors.

Hormones during pregnancy can also contribute as they sometimes cause tendon swelling. New mothers often develop this condition while holding their newborn to breastfeed.

What are the signs and symptoms of De Quervain’s Tenosynovitis?

The hallmark symptoms of De Quervain’s Tenosynovitis are pain and swelling at the base of the thumb. These may develop suddenly, or over a period of time. The symptoms are made worse by activities requiring forceful gripping, pinching between the thumb and another finger, movement of the thumb, as well as twisting of the wrist.

To diagnose this condition, your physiotherapist will perform a Finkelstein’s test. This involves creating a fist with the hand, then tilting the hand away from the thumb. A positive result is pain on the thumb side of the wrist.

How can physio help?

Your physiotherapist is trained to effectively assess the condition and begin your rehabilitation. In most cases, you will be managed alongside a doctor as well. Typically, you will be immobilized in a splint for 3-4 weeks, which allows the inflamed tissues to rest and heal.

Hormones during pregnancy can also contribute as they sometimes cause tendon swelling. New mothers often develop this condition while holding their newborn to breastfeed.

What are the signs and symptoms of De Quervain’s Tenosynovitis?

The hallmark symptoms of De Quervain’s Tenosynovitis are pain and swelling at the base of the thumb. These may develop suddenly, or over a period of time. The symptoms are made worse by activities requiring forceful gripping, pinching between the thumb and another finger, movement of the thumb, as well as twisting of the wrist.

To diagnose this condition, your physiotherapist will perform a Finkelstein’s test. This involves creating a fist with the hand, then tilting the hand away from the thumb. A positive result is pain on the thumb side of the wrist.

How can physio help?

Your physiotherapist is trained to effectively assess the condition and begin your rehabilitation. In most cases, you will be managed alongside a doctor as well. Typically, you will be immobilized in a splint for 3-4 weeks, which allows the inflamed tissues to rest and heal.

In severe cases your doctor may request a corticosteroid injection to assist the inflamed tissues to heal. Following splinting your physio can help with other treatments including electrotherapies (ultrasound, TENS or interferential therapy), stretching, and a graduated strengthening program.

Other methods of treatment to improve function of the thumb and wrist include increasing grip size on objects (pens, steering wheel), improving mechanics of the hand in sports, and altering hand and arm position when cradling bub for breastfeeding.

If symptoms persist at 3 months, your physio and doctor can assist you in deciding if surgery is indicated. None of the information in this newsletter is a replacement for proper medical advice. Always see a medical professional for advice on your individual injury.

WHAT IS IT?

Carpal Tunnel syndrome is a progressive disorder caused by compression of a key nerve in the wrist. The carpal tunnel refers to a space or “tunnel’ at the front of the wrist where tendons and nerves pass from the wrist to the hand. The median nerve is most commonly affected. This nerve controls sensation to the palm, side of the thumb and fingers, (excluding the little finger). The median nerve also sends impulses to some of the small muscles that allow the fingers and thumb to move.

SIGNS AND SYMPTOMS

Symptoms usually begin gradually with frequent burning, tingling or itching/numbness in the palm of the hand and fingers, especially the thumb, index and middle fingers. Your fingers may feel fat and swollen, even if they aren’t. Symptoms are often relieved by shaking of the wrists, even if only temporarily.

These symptoms may show up during the night as many people sleep with their wrists bent. Gradually, tingling symptoms may increase and grip strength may begin to weaken, which can affect your ability to form a fist, grasp small objects or perform other manual tasks. Left untreated, carpal tunnel syndrome can result in permanent nerve damage.

WHAT CAUSES CARPAL TUNNEL SYNDROME

Because this tunnel is made from the ligaments and bones of the hand, it is quite rigid, and any thing that causes the narrow space to be taken up can compress the structures that sit within. Often the tendons that pass through the carpal tunnel will become thickened or swollen through overuse, resulting in compression of the median nerve. People who suffer from thyroid or pituitary disorders, rheumatoid arthritis, diabetes, wrist dysfunction, work related stress or use of vibrating tools are more likely to develop this disorder.

Women are three times as likely to develop carpal tunnel syndrome as men, this is thought to be due to smaller wrist dimensions.

HOW CAN PHYSIOTHERAPY HELP?

Your physiotherapist or doctor can diagnose carpal tunnel syndrome with specific tests. Neck pathology can mimic carpal tunnel syndrome and it is important that a correct diagnosis is made. In many cases, symptoms can be resolved with physiotherapy, where you will be advised of rest, wrist splinting, exercises, manual therapy, dry needling and postural changes to prevent further injury.

Physiotherapy treatment is almost always recommended before considering other treatments such as surgical release or cortisone injection and is often very effective, particularly in mild and moderate cases. For more information, don’t hesitate to ask your physiotherapist.