01 Jul De Quervain’s tenosynovitis – Thumb injury
The most common injury to occur at your thumb is called De Quervain’s tenosynovitis. A bit of a mouthful!
A tenosynovitis is an inflammation of the fluid within a sheath that surrounds a tendon. Often, we describe the tendon sheath as glad wrap material around a tendon which protects the tendon and helps the tendon glide up and down as we use the muscle. With overuse, however, the fluid and sheath that surrounds the tendon can become inflamed and thickened.
The tendon sheath is innervated (has a nerve supply), so it is a pain producing structure. Repetitive friction results in irritation and pain with use.
At the thumb, this occurs in two tendons in particular; abductor pollicus longus, extensor pollicus brevis. Most people are able to localise the pain to about a 20-cent piece at the beginning of the thumb.
Onset of this condition is primarily insidious and builds over the course of a few weeks. Any activity involving repetitive use of the thumb will increase symptoms, such as desk and grip-based jobs.
The primary test for this condition is palpation of the appropriate tendons and the Finklestein’s test. The thumb is clenched in your hand as your deviate your wrist in the opposite direction. If positive, treatment consists of bracing, taping. Occasionally we will use ‘night wraps’ which consist of voltaren and hirudoid cream combined which can assist with the tendon swelling as the injury is quite superficial.
With appropriate treatment this condition can clear completely within a few weeks. If not addressed however, it will continue to affect you until you do something about it. So, don’t wait and hope it will go away, because it won’t!