Dequervain’s refers to an inflammation of the tendons of the thumb. This includes the extensor pollicis brevis and the abductor pollicis longus tendons. These tendons run from the thumb to the forearm and often the pain associated is located at the thumb or base of the wrist. It can be up the back of the forearm.
When these tendons are inflamed, there is pain with movement of the thumb one can also have redness and swelling present.
Dequervain’s is usually caused by a repetitive task that requires the extension or abduction of the thumb such as typing on the key board, use of a cell phone, or repetitive forceful flick of the thumb such as flipping a coin. The injury is not usually caused by one big thing, but the prolonged participation in the same low grade movement for an extended period of time.
One can test for Dequervain’s with Finklestein’s test. Finklestein’s test is performed by having the wrist and hand in neutral, oppose the thumb to touch the base of your pinky finger, grab the thumb with remaining fingers and tilt your wrist away from the thumb side. This puts a tremendous stretch on the tendons that are involved and is often extremely painful because the injured tendons are unable to stretch.
For treatment of Dequervain’s it is imperative to find out what the aggravating activity is and, of course, eliminate the activity. The tendon is inflamed to anti-inflammatory actions are appropriate including rest, ice, compression and elevation. If able and directed by doctor, one could take anti-inflammatory medication. The use of a brace that keeps wrist in neutral position and thumb abducted away from the hand is useful to eliminate inadvertent actions throughout the day. The brace is also helpful at night for the same reason because some people have a habit of keeping their wrists in flexed and rotated position for long periods of time when they sleep which is aggravating to the same thumb tendons.
As the acute inflammation of the tissue is decreased then it is appropriate to start gentle stretching such as the Finklestein’s test position. As the tendons heal, one could move further into the stretch with much less pain. Deep tissue massage is useful along the tendon to help free any soft tissue restrictions limiting the stretch of the tendon as well as invite blood flow to the injured tissue and promote healing.
A physical therapist is best suited to prescribe the correct dosage and progression of strengthening and stretching. As the person is able to tolerate the stretch with no pain, then it is time to start strengthening the tendons that were injured. This would include all motions of the thumb including opposition, flexion/extension, and abduction. Care should be taken to have the wrist in neutral position to promote good wrist mechanics for these actions. As the person gets stronger then return to normal activities should be encouraged including return to the most aggravating action. For example, if typing was the most aggravating action, then your physical therapist should be able to show you proper wrist mechanics to avoid recurrent injury. The same care should be taken to learn the correct mechanics of all actions such as gripping, pinching, pushing, pulling, and weight bearing.
Dequervain’s generally will take 2-3 months to fully heal. Early and correct diagnosis and treatment of the problem is important to stop the progression of the injury of the tendon.