De Quervain’s refers to a problem involving two of the thumb tendons. It is a common condition affecting new mothers and also office and manual workers (including physios!). In recent times, De Quervain’s has also become prevalent from excessive texting on mobile phones and is sometimes referred to as Blackberry Thumb, iPod Thumb, or Texting Thumb. Pain normally presents around the base of the thumb and/or the wrist. It is caused by overuse of the thumb tendons from either repetitive or sustained wrist deviation. New mothers often suffer from it due to holding their wrist in awkward positions for long periods of time whilst nursing their baby.
De Quervain’s can often be avoided by correcting wrist position to a more neutral position and by breaking up sustained or repetitive movement patterns. For new mothers, rest or avoiding certain wrist positions may not be practical and in that case, a brace may help to spread the load and reduce the likelihood of developing a De Quervain’s injury
Diagnosis of De Quervain’s is based on the location of pain, provocative activities/tests, such as the Finkelstein Test, and possibly also an ultrasound (although this is often not necessary). The two tendons involved are the extensor pollicus brevis and abductor pollicus longs. They may become irritated, inflamed, thickened or swollen.
Treatment varies depending on the severity of the condition. Anti-inflammatories or a cortisone injection may be recommended early on to settle down the pain. Other treatments include ice, bracing, shockwave therapy, dry needling and massage. However, the most important component of treatment for a tendon injury is strengthening exercises.
Strengthening exercises are usually essential in restoring normal thumb and wrist function. Even if the pain settles with other therapies, if the tendons are still weak they are vulnerable to re-injury. These exercises need to be prescribed by a physiotherapist so that they are matched to the current status of your De Quervain’s injury.
Other common thumb injuries include Skier’s thumb and osteoarthritis of the base of the thumb. Skier’s thumb results from the thumb being pulled back too far, causing one or more the thumb ligaments to tear. This injury needs to be assessed and graded by a qualified physiotherapist. Usually bracing is necessary to ensure that the ligament heals to its correct length. Occasionally, surgical intervention is required if the injury is more severe, involving the volar plate. If it is not managed properly there may be an increased risk of developing thumb osteoarthritis.
For more information, contact your physiotherapist.