DeQuervain's Tenosynovitis Rehabilitation Protocol

Justin C. Chipkin


Contents
Introduction
Step one: Heat-up
Step two: Range of Motion
Step three: Strength
Step four: Cooldown
References

What is DeQuervain's Tenosynovitis?

A tenosynovitis is an inflammation of a tendon (which attaches muscle to bone) and a synovium (which is a slick membrane that allows for the tendon to move easier). In DeQuervain's tenosynovitis there are two thumb tendons that lie on the back of the forearm and connect to the thumb. The two tendons become irritated from overuse movements that extend the thumb backwards and/or move the thumb away from the palm of the hand. The two thumb tendons arise from the muscles called the abductor pollicis longus (ABL) and the extensor pollicis brevis (EPB). There is a sheath that holds these two tendons in place and when the tendons become irritated and inflamed the sheath doesn't allow room for swelling to take place leads to a restriction in thumb movement that can be very painful.

1) Heat-up the thumb region- Always heat-up the area prior to stretching and exercises for 15 to 20 minutes. Suggested heating techniques:

A) Towel soaked in hot water
B) Heat Packs
C) Hot Tub

*Always use caution when applying heat to the body surface. The amount of heat applied should not exceed the patients comfort level. Use a dry towel as a barrier between the skin and the heat pack or hot towel to help protect the skin, as needed.

2) Stretching and Range of Motion- Restoring range of motion is a primary goal of all rehabilitation protocols. Once the area has been warmed stretching and range of motion movements should be performed prior to beginning exercises. Suggested stretching and range of motion techniques:

A) Wrist extensor stretch: Sitting next to a table with the forearm resting on the table, palm down, wrist bent and the hand hanging freely off the edge of the table. Using the uninvolved hand, bend the wrist stretching the muscles connected to the lateral elbow. Hold for 10 to 15 seconds, repeat 10 times.

B) Wrist flexor stretch: Sitting next to a table with the forearm resting on the table with the palm down. Using the uninvolved hand pull the wrist backward, bringing the palm off the table while making sure the forearm stays on the table. Hold for 10 to 15 seconds, repeat 10 times.

C) Opposition stretch: Resting your injured hand on a table, palm up. Touch the tip of your little finger to the tip of your thumb. Hold this position for 10 seconds. Repeat 10 times.

D) Ulnar deviation stretch: Seated, forearm resting on a table, thumb side up with the wrist off the end of the table. Using the uninjured hand push the wrist downward directing the little finger in the direction of the floor. Hold for 10 to 15 seconds, repeat 10 times.

3) Exercises- Exercises should be performed in 3 sets of 10 to 15 repetitions.

A) Wrist extension: In a seated position, palm facing up, forearm supported on a table, bend your wrist upward. Slowly return to the starting position. Resistance may be added to this exercise by holding a can of soup, a hammer, or a light aerobic weight.

B) Wrist extension: In a seated position, palm facing down, forearm supported with the wrist hanging off the edge of a table, bend your wrist upward. Slowly return to the starting position. Resistance may be added to this exercise by holding a can of soup, a hammer, or a light aerobic weight.

C) Radial deviation: In a sitting or standing position, place your wrist with the thumb up. Slowly bend your wrist in the direction of the thumb, as if to reach the thumb toward the ceiling. Slowly return to the starting position. Resistance may be added to this exercise by holding a can of soup, a hammer, or a light aerobic weight.

D) Ball Squeezes: Using a racquet ball, tennis ball, or a hand full of play-do, practice grip strengthening exercises by squeezing the ball. Perform 3 sets of 10 to 15 repetitions.

E) Finger spring/spreading exercises: Put a large rubber band around the outside of your thumb and fingers. Simply open the fingers and close them. You may also get a ball of play-do or silly puddy and by placing your finger tips into the ball, keep opening your fingers until the ball spreads the play-do/silly puddy out. Perform 3 sets of 10 to 15 repetitions.

F) Palm-down curls: Standing with your arms hanging naturally at your side, palm down and holding a light aerobic weight or even a can of soup. Slowly bend your elbow and bring your hand up toward your shoulder, then slowly back to the starting position. good practice is to count to 3 seconds to bend the elbow and 3 seconds to straighten the elbow. Remember that the palm is facing down the whole time. Perform 3 sets of 10 to 15 repetitions.

4) Cool down- Upon completion of exercises it is essential to cool the area down. Ensure that you cool the outside area of the elbow since this is the area that is injured and has the primary irritation. This will help control any inflammation, pain, and help enhance the healing process. Suggested techniques:

A) Ice Bag: A bag of ice placed over the injured area for 15-20 minutes.

B) Ice massage: Using a paper or Styrofoam cup filled with water, freeze it, and massage it over the area peeling the cup away as the ice melts for 15-20 minutes.

*Always use caution when applying ice or cold directly to the skin. Use a dry towel as a barrier between the skin and ice if needed.

*BE AWARE that ice causes a normal physiologic response and pattern of sensations; Cold, Burning, Aching, then Numbness (CBAN). If the ice is too uncomfortable use a cool towel.

References

1. Richie CA III, Briner WW. Corticosteroid Injection for Treatment of de Quervain’s Tenosynovitis: A Pooled Quantitative Literature Evaluation. J Am B Fam Prac. 2003; 16: 102-106.

2. Bongers PM, Ijmker S, van den Heuvel S, et al. Epidemiology of work related neck and upper limb problems: Psychosocial and personal risk factors (Part I) and effective interventions from a bio behavioural perspective (Part II). J Occup Rehabil. 2006 Sep; 16(3): 279-302.

3. Kutsumi K, Amadio P, Chunfeng Z, et al. Finkelstein’s test: A biomechanical analysis. J Hand Surg. 2005 Jan; 30(1): 130-135

4. Houglum, P. Therapeutic exercises for musculoskeletal injuries 2nd ed. Champaign, Ill. Human Kinetics; 2005. 838-67.

5. Pascarelli E, Hsu Y. Understanding Work-Related Upper Extremity Disorders: Clinical Findings in 485 Computer Users, Musicians, and Others. J Occup Rehabil. 2001 Mar; 11(1); 1-21.

6. Bernaards CM, Ariens G, Simons M, et al. Improving Work Style Behavior in Computer Workers with Neck and Upper Limb Symptoms. J Occup Rehabil. 2008 Mar; 18 (1): 87-101. Epub 2008 Jan 4.