THUMB TENDONITIS
 
Thumb Tendonitis
What is it?
Painful thumb tendons or de-Quervain's disease is characterised by either tenosynovitis or tenovaginitis. Tenosynovitis means inflammation in the tendon sheaths (these wrap around the tendons to protect them in the wrist), whereas tenovaginitis means the sheaths, or the tunnel they fit through, have shrunk and choke the tendons. 

The tendons involved are called Abductor Pollicis Longus (APL) and Extensor Pollicis Brevis (EPB). These tendons pass under a very strong band of fibres which is divided into compartments across the back (dorsum) of the wrist called the Extensor Retinaculum. The compartment these tendons use is called the 1st Dorsal Compartment. 

It affects 10 times more women then men and there is no specific cause but some underlying conditions are more susceptible to chronic thumb tendonitis like fibromyalgia and arthritis. Ball and bat sports also increase the risk of sudden injury caused by a hard blow to the base of the thumb leading to acute tendonitis or damage to the extensor retinaculum. 

Recent years have seen an increase in the number of thumb tendonitis cases related to repetitive strain caused by prolonged use of a mobile phone or tablet. In fact, the condition has become so common amongst young people that it has been given new names to reflect the probable cause. For example, texters thumb, iPhoneitis, and Mummy thumb.

During pregnancy and after childbirth hormones change the strength in tendons. Every day a new mum can lift her baby 25 to 30 times and this inflames the thumb tendons as they aren't given adequate opportunity to rest. Holding a bottle, buckling a seat belt and changing a nappy become painful tasks.
Thumb Tendonitis
How is it diagnosed?
To diagnose de-Quervain's disease your Hand therapist or doctor will examine your hand to see if you feel pain when pressure is applied on the thumb side of the wrist.

Your description of your symptoms and whether you had a recent injury to the thumb are important clues which influence the treatment chosen.

A test called a Finkelstein's manoeuvre is usually performed by the examiner to confirm the diagnosis. A lump on the tendons can be seen and felt and may make a crackling sound when the tendons are moved in acute cases with inflammation. Most times there is no visible swelling.

X-rays are not helpful as they don't show soft tissue damage. If your GP asks you to have an x-ray it is to rule out other diseases, such as osteoarthritis, at the base of the thumb.

Imaging using ultrasound is much more sensitive to signs of soft tissue inflammation and can help to tell if the condition is caused by tenosynovitis or tenovaginitis as treatment differs slightly for each kind. 
Thumb Tendonitis
Treatment
As soon as symptoms develop it is important to have appropriate treatment. De-Quervain's is not life threatening but if left untreated for more than a year it can become a persistent and painful problem that can only be helped with surgery.

If you experience acute thumb pain on movement and notice a lump on the tendon suggesting tenosynovitis or injury to the extensor retinaculum follow these R.I.C.E. steps:

Rest: The tendons need rest to allow healing to take place. Tendon fibres that are injured need to stay still as newly healing fibres are fragile. A thumb splint will allow you to keep active while preventing movement in the affected tendons.

Ice: Put an ice pack on the injury for up to 20 minutes every 2 to 3 hours to reduce swelling (you could use a bag of frozen peas wrapped in a tea-towel).

Compression: Use a sports wrist support to help reduce swelling. Learn from your Hand therapist how to apply sports tape to target the swelling in the local area. This is very popular and is easy to wear.

Elevate: Take an opportunity to raise the arm above your head as often as you can.

Without an ultrasound to confirm it, it is difficult to tell if thumb pain is caused by tenosynovitis or tenovaginitis. 
Tenosynovitis can be treated effectively with rest and splinting for 6 weeks. Tenovaginitis, on the other hand, does not usually improve with rest and splinting alone so other treatments are needed along side it. As most GP's do not have direct access to a Hand therapist for this treatment, it is usual practice to be recommended injection therapy from the outset. 

An injection of cortico-steroid into the compartment reduces thickening in the fibres and this removes pressure from the tendons. A second injection may be performed after 6 weeks. Not everyone wants or can have injection therapy so it is important to be aware that you have other options described above.

Surgery to expand the 1st Dorsal compartment is performed in some situations. It is important to have hand therapy afterwards to rehabilitate the tendons and muscles and to learn scar care.
Thumb Tendonitis
Treatment at Hand Kinetics
De-Quervain's disease is a painful condition that can have a huge impact on your life.

Early treatment can prevent the condition from becoming a chronic problem.

At Hand Kinetics you can expect an examination of the thumb, hand and wrist to check if other conditions are impeding repair and a treatment plan can be worked out.

Treatment will involve wearing a thumb and wrist splint continuously for 6 weeks with gradual introduction of exercises to build up strength in the tendons.

Massage and therapeutic ultrasound can be used to help speed up healing and remodelling of the tendon fibres. 

If you require it, we can organise an ultrasound scan to confirm the diagnosis at the Mourne Scan clinic and recommend the treatment most likely to help you to recover. This will take into account how long you have had your symptoms and which treatments you may have already tried.

Hand Kinetics Telephone: 0044 28 417 72301
www.handkinetics.com
contactus@handkinetics.com



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