Thumbs up for treating thumb pain in the hand therapy clinic

What do “Mommy’s thumb,” “gamer’s thumb,” and “radial styloid tenosynovitis” have in common?

• They are all officially called de Quervain’s tenosynovitis 
• De Quervain’s involves the tendons within the first dorsal compartment, abductor pollicis longus (APL) and extensor pollicis brevis (EPB) and arises when the tendons are inflamed and are not able to move through the surrounding sheath smoothly causing pain, inflammation and swelling

What causes it?

• A study done by Stanford researchers in 2017 found a possible genetic marker associated with de Quervain’s tenosynovitis, indicating that individuals with this genetic polymorphism are potentially at a higher risk of developing this type of thumb tendonitis (Kim, Ahmed, Avins, & Ioannidis, 2017)

• The initial cause is unknown however repetitive use of the thumb and wrist during activities such as lifting a baby or child, opening containers and jars or texting on a phone using the thumb repetitively can initiate symptoms
• Starting a new activity that requires repetitive use of the thumb
• Can be common among pregnant women or caregivers of young children who are constantly picking a child up/holding a child

What are the symptoms?

• Swelling at the base of the thumb  
• Painful popping when pulling, lifting, or opening objects/containers
• Raised cyst or nodule within the thumb area 
• Pain with gripping or pinching

What kind of special tests can be used to diagnose de Quervain’s?

• Finkelstein’s / WHAT Test
• X-ray imaging is typically not needed but can be used to rule out other conditions such as arthritis or fracture
• Sonography to image the 1st dorsal compartment, this has potential benefits as it can be checked dynamically

How can we treat it?

• Gamer’s thumb treatment should aim to reduce pain and inflammation and improve the patient’s functional use of the hand and thumb
• Splints or custom orthoses can be used to immobilize and provide support to the radial side of the wrist and the thumb and are used to reduce thumb pain treatment
  • Best type of custom orthosis is a thumb spica where the thumb and wrist are both stabilized during activity
• Stretching and resting the thumb and wrist can promote healing of the tendons
• Educating patients on how to avoid stress on the tendons involved such as avoiding repetitive movements with the thumb and radial side of the wrist and avoiding pinching with the thumb  
• Corticosteroid injection and antiinflammatory medications may be prescribed by a medical doctor to help subside inflammation
• In severe cases, surgery may be necessary to open the sheath surrounding the inflamed tendons, releasing pressure and providing room for the tendons to glide  

References

American Society for Surgery of the Hand. (2018). What is mommy’s wrist? Retrieved from http://blog.handcare.org/blog/2018/12/19/what-is-mommys-wrist/

Kim, S. K., Ahmed, M. A., Avins, A. L., & Ioannidis, J. P. A. (2017). A Genetic Marker Associated with De Quervain’s Tenosynovitis. International Journal of Sports Medicine, 38(12), 942-948. DOI: 10.1055/s-0043-116669

Mayo Clinic. (2019). De Quervain’s Tenosynovitis. Retrieved from https://www.mayoclinic.org/diseases-conditions/de-quervains-tenosynovitis/diagnosis-treatment/drc-20371337