PHYSIOTHERAPY FOR WRIST OVERUSE INJURIES

Do you have pain in your wrist?
Do you feel pain in the base of your thumb?
Is there swelling near the base of your thumb?
Do you experience pain with gripping or pinching?
Are you a parent and noticing pain when lifting your newborn baby?

You might be suffering with De Quervain’s tenosynovitis. De Quervain’s tenosynovitis occurs when the tendons at the back of the thumb become inflamed. This inflammatory process can cause pain and swelling of the base of the thumb. This blog will outline De Quervain’s tenosynovitis and effective strategies that can be used to manage symptoms.
De Quervain's Tenosynovitis

HOW DOES THE WRIST WORK?
The anatomy of the wrist is quite complex, so for the sake of simplicity, we will focus on the aspect of the wrist that De Quervain’s affects. In the above picture, the tendons pass through a tendon sheath, and then attach to the base of the thumb. De Quervain’s tenosynovitis is inflammation of the tendons that pass under the tendon sheath. The tendon sheath can be thought of as a guide pulley that acts to redirect the direction of the tendon. This sheath also lubricates the tendon as it passes underneath it. Inflammation of the tendons causes them to thicken, which makes the passage underneath the tendon sheath more restricted. This process causes pain and swelling to develop.

HOW DOES IT DEVELOP?
There are a variety of mechanisms for triggering this irritation of the tendon sheaths.
  • Repetitive wrist movements, especially those relating to thumb abduction (moving the thumb away from the palm/giving a thumbs up) and sideways movement of the wrist in the direction of the thumb
  • Mothers who lift their babies repeatedly, most notably from a loaded wrist position (pictured in the Risk Factors section)
  • Gaming with a controller in a loaded wrist position (also pictured in the Risk Factors section)

Tension-Headaches

WHAT ARE THE SYMPTOMS?
  • Primarily there is pain present on the thumb-side of the wrist
  • Constant pulling, ache and/or burning sensation
  • Painful pinching, gripping and extension of the thumb
  • Preceded by repetitive lifting, twisting or lifting (covered in more depth later)
  • Swelling and tenderness localised to the thumb-side of the wrist
WHAT ARE THE RISK FACTORS?
  • Repetitive lifting with the wrist in a thumb-up position
  • As pictured, the top of the wrist at the base of the thumb is loaded in this position
  • Repeated lifting of a baby from a cot can load the tendons that pass under the tendon sheath of the wrist
Tension-Headaches
  • Holding a controller or phone in a loaded wrist position
  • In this position the tendons of the wrist are held in a sustained stretch position
  • Depending on the length of time in this position, this can cause abnormal strain in the tendon
Tension-Headaches
  • Repetitive tasks such as gripping, pinching, wringing
  • Tasks that require a lot of force through the wrist such as wringing out a thick towel repeatedly can trigger symptoms much quicker
Tension-Headaches

HOW CAN I MANAGE MY SYMPTOMS AT HOME?
There are several strategies that can be attempted at home:
  • Minimisation of aggravating activities: With any repetitive strain injuries (RSI) the first course of action is to remove the negative stimulus.
  • Application of ice to the wrist: In order to reduce swelling and pain, ice is recommended. Heat is not recommended in this case due to the presence of swelling. However, a contrast bathing technique can also be employed where hot and cold stimulus is applied for equal durations to stimulate blood flow to remove swelling.
  • Painkillers: If tasks must be done, then painkillers can assist with completion without marked discomfort.

HOW CAN PHYSIOPHI HELP?
Tension-Headaches

  • Exercise Therapy: Specific exercises that target strengthening of the tendons involved in De Quervain’s tenosynovitis is an effective way to reduce pain from overuse. Gripping exercises help to further strengthen the muscles in the hand. Additionally, routine stretches would also be added to reduce pain with movement.
  • Tension-Headaches

  • Massage Therapy: Can be used to reduce local inflammation and assist with tissue mobility. Due to the mechanical nature of De Quervain’s tenosynovitis, the use of massage can be effective in restoring range and reducing pain.
  • Advice and Education: Information is absolutely vital to not only gain an understanding of the mechanics involved in De Quervain’s tenosynovitis but also to prevent future recurrences. Through our understanding of repetitive strain injuries and our ability to identify and flag occupational and social hazards, we can minimise flare-ups.

DISCLAIMER
At Physiophi, we have an in-depth understanding of repetitive overuse injuries that extends far beyond De Quervain’s tenosynovitis. Effective management of any injury stems from a comprehensive knowledge of the factors involved and individually tailored management strategies. If your wrist pain is not improving, book in an appointment with us to regain the ability to use your hand.
PLEASE CONTACT US ON: (07) 3172 4332 TO HAVE A CHAT WITH OUR FRIENDLY STAFF OR SIMPLY BOOK ONLINE ON: WWW.PHYSIOPHI.COM.AU
REFERENCES
  1. Allbrook, V. (2019). 'The side of my wrist hurts': De Quervain's tenosynovitis. Aust J Gen Pract, 48(11), 753-756. https://doi.org/10.31128/AJGP-07-19-5018
  2. Benites-Zapata, V. A., Jiménez-Torres, V. E., & Ayala-Roldán, M. P. (2021). Problematic smartphone use is associated with de Quervain's tenosynovitis symptomatology among young adults. Musculoskelet Sci Pract, 53, 102356. https://doi.org/10.1016/j.msksp.2021.102356
  3. Goel, R., & Abzug, J. M. (2015). de Quervain's tenosynovitis: a review of the rehabilitative options. Hand (N Y), 10(1), 1-5. https://doi.org/10.1007/s11552-014-9649-3
  4. Meals, R. A. (2015). Efficacy of acupuncture for De Quervain's tenosynovitis. J Acupunct Meridian Stud, 8(1), 1. https://doi.org/10.1016/j.jams.2014.11.006
  5. Nakamura, T. (2019). De Quervain's Tenosynovitis. J Wrist Surg, 8(2), 89. https://doi.org/10.1055/s-0039-1683984
  6. Oh, J. K., Messing, S., Hyrien, O., &Hammert, W. C. (2017). Effectiveness of Corticosteroid Injections for Treatment of de Quervain's Tenosynovitis. Hand (N Y), 12(4), 357-361. https://doi.org/10.1177/1558944716681976
  7. Tamura, H., Shikino, K., Uchida, S., &Ikusaka, M. (2020). de Quervain's tenosynovitis. BMJ Case Rep, 13(12). https://doi.org/10.1136/bcr-2020-240129

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