Do you have thumb pain? Don’t know how it got there? Or more importantly…how do you get rid of it!!
This week I am going to discuss De Quervain’s tendinitis, which is also known as radial styloid tenosynovitis. It is usually pain around the thumb/wrist area when you go to grab something like a jug of milk or to turn the door knob. De Quervain’s is the inflammation of the tendon’s that open the thumb (extensor pollics brevis and the abductor pollis longus) in that particular area near the wrist. There is a thin tissue (the sheath) that holds the tendons in place that can get thick and make it harder for the tendon to glide. The anatomy of every person can vary greatly in that area which makes it hard to know why it happens in some people and not in others.
Factors such as repetition of motion like heavy gripping with twisting of the wrist when opening jars, grabbing thick charts, cutting with scissors, or holding forceps can cause pain at the thumb/wrist area. A fall on an out stretched hand or sudden wrenching of the hand during a fight can also cause pain at the thumb/wrist area. DeQuervain’s tendinitis also tends to occur more in females then males, and around ages 35 to 55 years old. Not to say you cannot have it otherwise, this is just generally more common. In my professional experience, I have treated many more women then I have men. Usually with men, there’s an acute trauma that has caused it, whereas in women that I have treated, it is due to the repetitive nature. Occasionally, it is due to pregnancy or after.
So now you have thumb pain, you know maybe how you got it or at least what it is. What can you do about it? Well, for one, stop doing what you are doing that keeps it hurting! I know…I know…that is way too hard because we need our hands for everything. It doesn’t always hurt at first, only when you do that gripping, twisting motion. But then it will start to hurt more and more without doing anything, it will just be painful constantly. Please don’t let it get to that point because by then, it’s much harder to get rid of! If you go to the doctor, a lot of places put you in a prefabricated “thumb spica” splint. Sometimes that’s great, it’s definitely the cheaper way. But take a look at how it fits. The tip of your thumb should be sticking out, and you should be able to bend it all the way down and all the way up. The splint should only stop you from moving wrist and part of your thumb. I know, it’s cheaper than a custom fitted orthosis (splint). But it may not always be the best fitting. Just make sure it is not causing you MORE pain! Well, you got it, might as well try it. If it is NOT WELL FITTED, visit with your occupational therapist/certified hand therapist and get a custom fitted on made to fit your hand. There’s some research out there that says if your wrist is placed slightly in ulnar deviation (angled a little to the side of the pinky) that it can be helpful.
Besides the splinting, which is forcing you to rest that hand and wrist and let the swelling go down, make sure you can come out of the splint at times and gently move your thumb and wrist in a pain-free way so that you do not get stiff in the splint. You can also massage the area to help get rid of any swelling that is stuck there, and free any scar tissue that is hardening up that area. I am a huge lover of icing that area as well to reduce the pain and swelling. I also like to use Kinesio taping to help with the pain without having to use the splint, it just allows you to be more functional. Studies show that in the most painful stages, occupational therapy and splinting cane help. But results from cortisone injections are much more effective at getting rid of the pain faster. You can talk to your doctor if that is the right option for you.
Surgery is considered only if you tried all the conservative methods and nothing has worked for you to get rid of the pain in order for you to be fully functional with all your activities. It is usually that persistent interference of quality of living and working that gets people to the point where they are ready for surgery. The procedure is an outpatient procedure. Your size scar and technique depends on your doctor. You will need some amount of occupational/certified hand therapy to help you with your pain, scar, and motion. Generally speaking, you can a use a splint for about 2-3 weeks, but you can start therapy within 7-10 days. Progression with range of motion and strengthening should be pain-free, and by 6-8 weeks be able to able to return to some moderately heavier activities.
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As always, thank you for your time!
Hands on Therapy Services is a leading Miami certified hand therapist, specializing in rehabilitation of shoulder, elbow, wrist, and hand injuries (including thumb pain) resulting from injuries, surgery, or naturally occurring conditions. Our Miami hand therapy services are provided by our certified hand therapist in Miami. We also offer occupational therapy in Miami with our on site occupational therapist. Plus – coming soon – we will be offering physical therapy in Miami.
Disclaimer: As with all our pages, this is NOT a substitute for formal medical treatment or occupational therapy. It is intended to inform only. Hands on Therapy Services disclaims any liability for the decisions you make based on this information.