In 1895, Swiss surgeon Fritz de Quervain first described a painful condition of the wrist and thumb area. This condition, which worsens with thumb movement, was aptly named De Quervain’s Syndrome. What’s going on in the anatomy of something with De Quervain’s syndrome? What are the symptoms? And most importantly—is there any way to treat the thumb and wrist pain of this disorder in a natural and non-invasive way?

Tendons, Sheaths, and Wrist Anatomy

To understand De Quervain’s Syndrome, it’s important to visualize the muscles and tendons of the wrist and thumb. We all know what muscles are, but what exactly is a tendon?

A tendon is a tough, fibrous structure that helps connect muscles to bones to aid in the movement of limbs. In tendonitis, pain is caused by the tendons themselves being inflamed. Tendons are covered in tendon sheaths, which are thin membranes that help the tendon move. In tenosynovitis, the tendon sheaths themselves are inflamed, which leads to pain and malfunction.

Okay, so that’s what the tendons and tendon sheaths do — but what do they have to do with De Quervain’s Tenosynovitis?

In the wrist, two long muscles attach along the length of the hand on the radial, or thumb, side of the wrist: Abductor pollicis longus and extensor pollicis brevis. Together, they aid in motions of the wrist and thumb. They pass through the “dorsal compartment” of the wrist, which can be visualized as a tunnel through which muscles run. The muscles run through the tunnel, then attach to the bone with tendons.

In De Quervain’s Tenosynovitis, the tendon sheaths of abductor pollicis longus and extensor pollicis brevis cause all the trouble. When the tendon sheaths become inflamed, they begin to entrap the tendons of the two muscles. This causes pain and discomfort of the area.

Symptoms and Causes of De Quervain’s Tenosynovitis

Due to inflammation of the tendon sheaths, people who have De Quervain’s tenosynovitis might experience the following:

  • Pain and swelling near the base of your thumb
  • Pain while doing something that involves grasping or pinching motions
  • It may feel like aching, pulling, or burning.

What causes the inflammation in the first place?

Experts believe it’s caused by repetitive thumb use combined with radial deviation of the thumb, which basically means its associated with twisting, wringing, or pinching motions of the wrist and thumb. Commonly associated with the motion of lifting a newborn, De Quervain’s can be found in new parents or employees of day cares where there’s semi-constant lifting of children.

Some other activities that can aggravate the condition are gripping a hammer, wringing a washcloth, or twisting a jar lid. Basically, any motion that involves twisting or pinching with the thumb side of your wrist and hand can be aggravating to those with De Quervain’s Syndrome. As in most inflammatory conditions, motions that make use of the area will often make symptoms worse.

When to See a Physical Therapist for Thumb & Wrist Pain

If you’re finding yourself facing pain and burning at the base of your thumb, and it’s gotten worse over time, it might be time to seek treatment. Although there are surgeries available that open up the dorsal compartment of the wrist, it’s generally less invasive to seek a physical therapy solution to the problem. Instead of surgery, a trained physical therapist will work with you on the following:

  • Identify motions that make it feel worse, and help you work with your current limitations to work smarter, not harder.
  • If necessary, immobilize the joint for a brief period of time to decrease inflammation. This option might help for a brief time if the inflammation has gotten out of hand.
  • Helping you develop exercises that strengthen and stretch surrounding muscles. Physical therapists work with tried-and-true techniques based on the best science of anatomy to strengthen the surrounding muscles and take some of the pressure off the problematic tendons and muscles.

It’s important to seek help for De Quervain’s tenosynovitis right away so that it doesn’t escalate into arthritis or cause lasting damage to the tendon and tendon sheath. If you’re suffering from the symptoms of De Quervain’s Syndrome and you’d like to make an appointment for a consultation, reach out to a qualified physical therapist today. Cawley Physical Therapy & Rehabilitation understands how to work with your condition for the best results: call 570-208-2787 to discuss gentle and non-invasive exercises and therapy for your thumb and wrist pain.

– Dr. Jesse Yurko DPT

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