In this week’s article, I will discuss a painful condition that affects the base of the thumb. The condition is called De Quervain’s tenosynovitis which causes pain and tenderness into the palm of the hand at the base the thumb. It affects the two tendons of the thumb that travel down through forearm and down into the thumb side of your wrist. These tendons are used when you grasp a towel or fetch something from a shelf with your hand. With constant repetitive movements of the wrist and thumb, inflammation develops in the slippery surface called the synovial sheath that covers these two tendons (called Extensor Pollicis Longus and Abductor Pollicis Brevis) as they pass through the wrist. The synovial sheath’s function is to protect the tendons from friction from surrounding bones in the wrist, when the sheath becomes inflamed; the following symptoms can be felt;
Pain and swelling will be noted in the palm of the hand at the base of the thumb. The pain may spread into the forearm or further into the thumb.
Activities involving movement of the thumb and twisting of the wrist causes pain.
Muscle weakness in the thumb is often noted overtime.
A feeling of restriction may be felt in thumb.
Numbness may also be felt in the back of the thumb and index finger.
The condition commonly affects musicians, housewives, carpenters, builders and office workers, whilst it can commonly affect sports people such Golfers and tennis players. Other causes of De Quervain’s tenosynovitis include, trauma to the wrist tendons resulting in scar tissue formation leading to restriction. In addition inflammation arthritic conditions such as Rheumatoid Arthritis can lead to swelling of the synovium sheath thus bringing about De Quervain’s tenosynovitis.
Management of De Quervain’s Tenosynovitis
Patient’s attending my clinic with De Quervain’s Tenosynovitis are advised to rest the hand from repetitive actions that aggravate the pain. This is achieved by wearing a splint to rest the thumb at night-time and possibly during daytime. This serves to prevent continuous inflammation of the inflamed synovium sheath. In addition I often carry out gentle friction massage to the restricted tendons in order to increase mobility of the wrist and thumb. In more severe cases steroid injection or even surgery may be required to heal the condition.
Next week I will discuss a further condition that refers pain into the arm, hand and fingers.
Tomás Ryan is a Registered Physical Therapist with The Irish Association of Physical Therapy and is based in Clonmel & Thurles.
Contact Number: 0504 26672
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