De Quervain’s Tenosynovitis is one of the many common disorders often reported to occur as a result of “Cumulative Trauma.” Most prevalent in women (4 : 1 ratio), the incidence is highest in the age category of 35 to 55 year olds.
Etiology: Activities that result in forceful, repetitive or sustained thumb abduction (hitch hiker) with ulnar deviation (little finger moving towards the outside portion of the forearm) are often associated with development of DeQuervain’s symptoms. Activities that are most commonly performed in the workplace that result in this movement include: opening of jars, wide grasp such as with pliers, thumb pipetting or lifting in a manner similar to picking up a child under their arms. While acute trauma, such as a sudden forceful pull to the thumb, can result in De Quervain’s symptoms, incidence is very low.
Symptoms: Symptom most commonly presents as pain on the thumb side of the wrist. In more advanced cases, swelling and/or triggering (catching) can occur with thumb movement. Clinically, De Quervain’s is often diagnosed via a positive (+) Finkelstein’s test.
Pathology: Pain is a result of inflamed tendons of the thumb (APL and EPB) irritating the sheath (first dorsal compartment) through which they pass. As the irritation progresses, the sheath will thicken and as a result, the tendons are unable to glide smoothly.
Treatment: Initial treatment should focus on the reduction of inflammation via thumb immobilization and anti-inflammatories. Spica splints are often provided by an occupational therapist to prevent excessive thumb extension/abduction. Therapy should focus on modalities for inflammation such as iontophoresis, and manual mobilization to reduce the risk of excessive scarring and adhesions during the healing phase.
Prevention: With job tasks that require repetitive hand movements, particular attention should be given to the hand positioning. Tasks should be completed with hands kept in neutral position, avoiding wide grasp and repetitive triggering with the thumb or fingers. “Ergonomically” designed tools may reduce risk due to the design “encouraging” use in a safe upper extremity posture.