When treating patients with de Quervain’s Tenosynovitis, they may complain of a swollen thumb and radial-sided wrist pain. The pain may become worse, and may radiate up the thumb or forearm, during activities that require abduction or flexion of the thumb. In most cases, de Quervain’s is caused by overuse or repetitive stress, although the condition may develop for unknown reasons.
Recognizing Symptoms of de Quervain’s
- Radial-sided wrist pain with or without inflammation at the base of the thumb
- Pain with thumb abduction or flexion
- Inflammation over the thumb side of the wrist
- A snapping or catching sensation when moving the thumb
- Numbness of the back of the thumb that may spread to the index finger
Treatment of de Quervain’s
Since the pain of de Quervain’s is tendinopathic, physical and occupational therapy that includes nonsteroidal agents, cryotherapy, and topical corticosteroids mediated with ultrasound and iontophoresis are often helpful in managing the symptoms.
Splinting remains a first-line conservative treatment. Depending on the severity and longevity of the symptoms, splinting choices may be soft flexible splints for mild or occasional symptoms, moderately restrictive splints for more severe and persistent symptoms and firm supports that restrict motion for more severe, long-standing pain.
These splints offer varying levels of support and restriction of motion:
- 3pp ThumSpica – a lightweight wrap that positions the thumb for protection and reminds the wearer to avoid stressful positions.
- 3pp ThumSpica Plus – the addition of a custom-molded splint and the soft ThumSpica wrap offer greater control of thumb motion with minimal limitation of wrist motion.
- Mueller Thumb Stabilizer – provides firm control for rest with limited activity.
It is important to follow patients after a splint is issued. If symptoms do not improve with a full time splint wear regime, patients should be referred for treatment or a surgical release.
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