De Quervain’s syndrome is an idiopathic tendinosis of extensor pollicis brevis and abductor pollicis longus. These two thumb muscles move the thumb in extension (away from the hand in the same plane as the hand). The tissue in the retinaculum at the base of the first digit thickens creating less space for the canal. This compresses the tendons and their sheaths. There is generally a repeating cycle of use, breakdown and thickening until pain exists even at rest and interferes with all manual tasks.
Most people who have De Quervain’s syndrome work with their hands. Common triggers include painting, knitting, sewing, cutting, typing, fly fishing, hammering and scrapping wallpaper. It should be noted that a sub-population within this population exists of young mothers. About 15% of those with this condition are mothers with children less than 5 months old. What has been found is they are repeatedly lifting their child with their thumbs in extreme extension or extreme abduction hundreds of times causing the syndrome. Unfortunately it becomes very difficult under these conditions to rest given the continual care the newborn requires. Proper hand strength and proper alignment while lifting the child appear to be the best practice to avoid this problem.
In cases caught early, there is only localized swelling and tenderness and the radial styloid process and the base of the thumb. In more advanced cases, patients report joint “creaking” with severe pain, and a noticeable thickening of the extensor sheath leading to loss of abduction at the CMC joint. The crepitus can be heard and felt if the therapist correctly places their hand on the tendon and moves the joint through the range of motion affected.
It is primarily diagnosed by the history (recent pain along the radial aspect of the wrist that worsens with ulnar deviation or radial deviation) and confirmed by Finklestein’s test (however we strongly caution against home testing as other problems like nerve entrapement and wartenberg’s syndrome will also test positive). A Finklestein’s test can be seen here. We still believe in seeking proper medical advice from a professional who is qualified to differentiate this condition from others and refrain making snap decisions from a 30 second internet clip and self-splinting (perhaps in the wrong position).
In the case of early intervention, rest and splinting with a few weeks followed by a stretching protocol is generally enough to reverse the condition. If it is more advanced, manual therapy, splinting and exercise therapy and extensive rest (on the order of 3-6 months) would be the protocol. In severe cases, corticosteroid injections to the site would be used to try to reduce inflammation with a total rest protocol. These cases are much harder given our frequent use of our thumbs in daily life for anything from holding a pen to holding a mug to a hand shake to snatching a kettlebell.
Prevention is key as proper strengthening and stretching with proper use of the hands can prevent this condition in many cases.