Thumb Pain: What is De Quervain’s Tendinosis & How Do You Fix It?
Gamer’s Thumb. Mommy Thumb. Texting Thumb.
They’re all different names for the same painful problem, in which the tendons that attach to the thumb rub against the “tunnel” that surrounds them and become inflamed. The medical term is De Quervain’s tendinosis (aka De Quervain’s tenosynovitis) and it can cause anything from mild discomfort to debilitating pain where the thumb meets the wrist, oftentimes radiating up the forearm.
Though De Quervain’s tendinosis can happen to anyone, you’ll most often find it in new moms, gamers and those who spend excessive time texting on their phones. Gardening, racquet sports, skiing, playing a musical instrument and using a hammer are also common causes. And women have it worse – a 2009 study from the University of Colorado found that women are four times more likely to develop De Quervain’s than men. The study also found that people over 40 years old were more than three times as likely to get De Quervain’s as younger people.
There’s a simple way to test for De Quervain’s tendinosis called the Finkelstein test. To do it, make a fist with your fingers wrapped over your thumb (thumb up, pinky down). Keeping your hand in a fist position, tilt your hand down toward the floor. Pain on the thumb side of your wrist with this movement is a positive indicator for De Quervain’s tendinosis. And while it’s not a perfectly reliable test, if your pain is exacerbated with it you can be reasonably confident you’re dealing with De Quervain’s.
Besides the obvious pain, other distinctive symptoms of De Quervain’s tenosynovitis include:
• Swelling near the base of your thumb.
• Numbness along the back of your thumb and index finger.
• A “catching” or “snapping” feeling when you move your thumb.
• A “squeaking” sound or feeling as the tendons move within the swollen sheaths.
So what actually causes De Quervain’s Tendinosis?
The term tendinosis refers to the damage and inflammation of a tendon – a band of tissue that attaches muscles to bones. At the base of the thumb, the tendons of the extensor pollicis brevis and abductor pollicis longus muscles pass through a tunnel called a tendon sheath. This sheath usually allows the tendons to glide smoothly over the first metacarpal (the bone in your hand that connects your wrist to your thumb) without difficulty or pain.
However, problems occur when the first metacarpal shifts (usually laterally and proximally) and the joint between the first metacarpal and the trapezium in the wrist loses its proper alignment. You don’t need to be a radiologist to see the difference between a normal carpometacarpal joint (on the left in the x-ray below) and one that’s not aligned correctly (right), putting extra stress on the tendon sheath that runs alongside it.
The smooth gliding motion of the tendons can also be affected by direct injury to your wrist (leading to scar tissue formation), pregnancy (due to hormonal changes), or by inflammatory arthritis, such as rheumatoid arthritis.
When you combine this extra stress on the tendon sheath with repetitive activities that rely on hand or wrist movement, such as working in the garden, playing golf or racket sports, or lifting a baby over and over, you’ve got a perfect storm for inflammation.
How Do You Fix It?
Unfortunately, De Quervain’s rarely goes away on its own, but doctors agree early diagnosis and treatment are key.
Rest & Ice: De Quervain’s is a type of repetitive strain injury, so unsurprisingly, the first step is to avoid repetitive thumb movements as much as possible. Avoid lifting and try to limit smartphone use whenever possible. Sliding, scrolling, and tapping away on your iPhone is just going to compound the inflammation and prevent proper healing.
Icing your wrist frequently (for 10 to 15 minutes at a time) and over-the-counter NSAIDs, such as ibuprofen (Advil) and naproxen (Aleve), have been shown be helpful. Resting the hand on a pillow or elevated surface helps too.
Chiropractic & Soft Tissue Therapy: Correcting the positioning of the carpometacarpal joint with chiropractic care and treating the soft tissues surrounding the joint can bring quick relief, minimizing inflammation and pain. As the pain decreases, we’ll usually prescribe specific strengthening and stretching exercises that involve the wrist, thumb, and forearm to help keep the joint aligned correctly.
Stabilization & Immobilization: After treatment, we’ll usually use tape to provide compression and stabilization to the joint. The type of tape we’re going to use here is kinesiology tape – a stretchy, movable tape that can support proper thumb and wrist positioning without totally restricting your range of motion.
At Ascent Chiropractic we use RockTape kinesiology tape because it can provide support for a full week and will stay on even after you’ve showered.
For more severe cases, a spica splint that immobilizes the thumb can be effective in helping to reduce swelling of the tendon. Depending on the severity and longevity of the symptoms, splinting choices may be soft flexible splints for mild or occasional symptoms, moderately restrictive splints for more severe and persistent symptoms and firm supports that restrict motion for more severe, long-standing pain. Consistency is key with a splint – you’ll typically need to wear it 24 hours a day for several weeks.
Next Steps
The good news is that De Quervain’s tenosynovitis isn’t a permanent condition and it generally responds well to treatment. Most patients will be back to their pain-free selves within 4 to 6 weeks of treatment.
Dealing with De Quervain’s and looking for a Brookfield Chiropractor? At Ascent Chiropractic we’re committed to not just relieving symptoms but to correcting their cause and optimizing your body to function better than it ever has before.
Discover the difference personalized, comprehensive care at Ascent Chiropractic makes. Instead of just fixing your pain, let’s fix you. To schedule an appointment, call us at 262-345-4166 or use our online scheduling app.
About the Author
Thank you for the easy to understand explanation. Although I haven’t been officially diagnosed with this ailment, I had the excruciating pain 2 days ago. But now, after having treated myself with PEMF therapy, I am happy to say that I am almost pain free. I wish this therapy was more widely known.