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, making stretching a part of your fitness regime will have a significant impact. To get you started on a safe and effective stretching routine learn more about The Stretching Handbook and how it can improve your fitness.

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.

Stretching is one of the most under-utilized techniques for improving athletic performance and getting rid of those annoying sports injuries. Don't make the mistake of thinking that something as simple as stretching won't be effective.

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