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Treating and Preventing DeQuervain's Syndrome

What is DeQuervain's Syndrome and what can you do to find relief?

The thumb and wrist are used in many actions during the course of a day. Gripping, holding, lifting, turning handles, driving a car and many other daily manoeuvres require the thumb and the wrist. The joints are held together by strong ligaments and tendons. These are attached to the muscles that contract and relax to facilitate movement.

These ligaments and tendons provide support and allow for movement in the joints. The tendons and ligaments can be injured by acute forces outside the normal range. They can also be injured or become inflamed, from overuse. Quervain's syndrome is one of those injuries to the thumb and wrist that can be very painful and, in extreme cases, debilitating.

If you suffer from Quervain's syndrome or are seeking to prevent its occurrence it is important to follow the information in this article. In addition, adding a few simple stretches to your fitness program will also help. To get started on a safe and effective stretching routine that's just right for you, check out the Ultimate Guide to Stretching & Flexibility.

What is Quervain's Syndrome?
De Quervain's syndrome (also referred to as de Quervain's tenosynovitis, Radial styloid tenosynovitis, washerwoman's sprain or mother's wrist) is a condition named for the Swiss surgeon Fritz de Quervain, who identified the condition in 1895. It is an inflammation of the sheath or covering, of two tendons of the thumb. This inflammation causes compression of the tendons, reducing their ability to slide through as needed for movement.

This condition is not commonly associated with any disease process or dangerous condition. It does, however, often require medical intervention to improve. This syndrome is more common in women than in men. Quervain's syndrome is similar to tennis elbow and carpal tunnel syndrome as a condition brought on by overuse.

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Anatomy Involved
This condition involves two of the tendons that control movement in the thumb. These tendons, the abductor pollicus longus (APL) and the extensor pollicus brevis (EPB), are attached to muscles on the back of the forearm. These tendons travel side by side on the inside of the wrist. At the wrist they travel through an opening at the end of the radius bone, which serves as a guide. The lining of the opening, the tenosynovium, provides a slippery surface for the tendons to glide over as they move the thumb.

Inflammation of a tenosynovium is called tenosynovitis. In the case of Quervain's tenosynovitis, the inflammation causes an impingement of the tendons in the tunnel, causing friction on the tendons, further inflaming the tenosynovium and tendons.

What causes Quervain's Syndrome?
Quervain's syndrome is an overuse injury like many other tendon injuries. Continuous gripping, pinching, squeezing or wringing motions can lead to this condition, hence the name washerwoman's sprain. New mothers may also develop the condition from cradling their baby in the same arm for extended periods (thereby earning the name mother's wrist.)

Injury to the wrist or thumb may lead to the development of scar tissue in this area, and as the scar tissue develops the tendons become impinged. Arthritic conditions can also lead to tenosynovitis on the thumb. Arthritis is an inflammation, commonly found in joints, and so therefore this inflammation exacerbates the condition.

Signs and Symptoms
Pain in the thumb and lateral wrist, over the radius, especially during use, is common with this injury. Tenderness and swelling over the area may also be present. The pain may progress further up the forearm as the injury worsens. A progressive loss of function in the thumb may occur due to the increasing pain. The range of motion of the thumb may begin to decrease. Crepitus, or a creaking, may be experienced in the affected area.

Treatment
Rest, ice and NSAIDs may provide relief and reversal of this condition, especially if it is caught early enough. Splinting with a thumb-spica splint may be necessary to reduce the movement of the wrist and lower joints of the thumb. If these interventions do not work, then a cortisone shot into the irritated area may be the next course of action. Physical therapy may also be used to retrain movements to avoid or change the method of those daily actions that caused the inflammation.

The final step, if all other interventions fail, is surgery to release the tendons and provide more space for them to move. Following the surgery physical therapy may still be required to retrain the movements that caused the injury.

Prevention
Prevention of overuse injuries commonly requires breaking up sessions of work or practice involving a particular area into shorter periods with more frequent breaks to allow that area to rest and avoid the overuse.

  • A proper warm up before doing any lifting, grasping or holding for extended periods may prepare the tendons for the task and prevent some of the strain placed on them.
  • Avoidance of activities that cause pain is a common sense prevention method that often gets ignored. If a movement causes pain, find another activity or action that accomplishes the same task without the pain.
  • Flexible muscles reduce overall tension on the tendons, which reduces the inflammation to the sheaths that cover them.

The Stretching Handbook, DVD & CD-ROMWhile the recommendations on this page are a good starting point, you'll get a lot more benefit when you include a wider variety of exercises. So to improve your athletic ability, reduce injuries and really take advantage of all the stretching exercises on offer, grab a copy of the Ultimate Guide to Stretching & Flexibility (Handbook, DVD & CD-ROM).

In total, they include 135 clear photographs and 44 video demonstrations of unique stretching exercises for every major muscle group in your body. Plus, over 80 printable stretching routines for 22 sports and 19 different muscle groups.

The DVD also includes 3 customized stretching routines (8 minutes each) for the Upper Body; the Lower Body; and the Neck, Back & Core, plus a bonus CD-ROM that allows you to print out over 80 stretching routines that you can take with you wherever you go.

The Handbook and DVD will show you, step-by-step, how to perform each stretch correctly. Plus, you'll also learn the 7 critical rules for safe stretching; the benefits of flexibility; and how to stretch properly. Check out the Ultimate Guide to Stretching & Flexibility for yourself.

  • Muscles that are trained regularly are more supple and repair quicker. They are also much less prone to injuries that can lead to tendon issues.
  • Rest is essential for healthy joints, tendons and ligaments. These structures cannot repair when they are under stress. They need rest to repair damage and rebuild.
  • Eating a diet with essential fats and oils for lubrication, protein for repairs and calcium for strong bones, along with other vitamins and minerals will reduce the risk of injury and provide the nutrients needed to stay healthy.
  • Strengthening the wrist and forearm will provide the support needed in the wrist to prevent this condition. It is important not to contribute to the overuse syndrome through training, however, by choosing exercises that do not directly simulate the overused motion.
  • Avoiding the repetitive motions that cause this condition and retraining the body to reduce the strain on the wrist during daily activities will also help prevent Quervain's syndrome
 

Article by Brad Walker and Injury Fix™
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Brad WalkerAbout the Author: Brad is often referred to as the Stretch Coach and has even been called the Stretching Guru. Magazines such as Runners World, Bicycling, Triathlete, Swimming & Fitness, and Triathlon Sports have all featured his work. Amazon has listed his books on five Best-Seller lists. Google cites over 100,000 references to him and his work on the internet. And satisfied customers from 122 countries have sent 100's of testimonials. If you want to know about stretching, flexibility or sports injury management, Brad Walker is the go-to-guy.