Radial Wrist Pain, or De Quervain’s Tenosynovitis?



Today we are going to dive into a disease that is commonly seen in out-patient physiotherapy setting. De Quervain’s tenosynovitis is a common disease of the wrist. This disease is characterized by swelling and thickening of the extensor retinaculum that covers the dorsal aspect of the thumb. The tendons of the abductor pollicis longus and extensor pollicis brevis run through the retinaculum, which is a tunnel-like structure. Repetitive gliding of the tendons against the retinaculum will cause swelling and inflammation of the retinaculum, ultimately causing pain over the styloid process of the radius.


De Quenvain’s tenosynovitis occurs 10 times more likely in women than in men. It typically occurs in patients ages 30 to 50 years old. On examination, clinicians often use the Finklestein’ test to confirm the diagnosis. The test is positive when there is pain with passive ulnar deviation. Swelling and pain on palpation of the styloid process also confirm the diagnosis.


Activities which require repetitive movement of the thumb, such as texting or frequent use of video game controller, will also predispose individuals to this disease.


Research has shown that a multimodal approach, including corticosteroid injections, splinting, physical therapy, and oral nonsteroidal anti-inflammatory drug administration provide more benefits than when either one is used in isolation. Although surgical intervention has the most successful outcome, it is the last resort after combination of conservative treatment fail after 6 months.


If you are experiencing wrist pain on the thumb side, you might have de Quervain’s tenosynovitis and our physiotherapists are able to help you recover in no time!


References:

Abi-Rafeh, J., Kazan, R., Safran, T., & Thibaudeau, S. (2020). Conservative Management of de Quervain Stenosing Tenosynovitis: Review and Presentation of Treatment Algorithm. Plastic and reconstructive surgery, 146(1), 105-126.


Tamura, H., Shikino, K., Uchida, S., & Ikusaka, M. (2020). de Quervain’s tenosynovitis. BMJ Case Reports, 13(12).

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