De Quervain's Stenosing Tenosynovitis



Thumb Tendinitis, de Quervains Tenosynovitis, de Quervains Stenosing Tenosynovitis, Quervain's Stenosing Tenovaginitis (sometimes referred to as "new mom's syndrome")

If you have contracted De Quervain's Stenosing Tenosynovitis, you will notice a painful irritation below the thumb in the area of the wrist (see image for detail). The tendons that straighten the thumb pass over the back of the wrist and run through a tunnel known as the "first dorsal compartment". It is this area where the pain will manifest itself.

A De Quervians injury means that the lubricating sheath (sheaths help tendons slide with less friction) that lines the tunnel has thickened and swelled. This swelling reduces the available room for the thumb tendon to move. Scar tissue may form between the lining of the sheath and the tendon, further restricting thumb movement.

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de Quervain's Syndrome is an inflammatory condition that is commonly caused by cumulative injury, and is one of the most common diagnosed conditions treated by hand surgeons. Carpal Tunnel Syndrome - also theorized to be caused by repeated and cumulative trauma, is one of the major causes of lost workdays at the present time. Regarding de Quervain's tenosynovitis, there is potential for symptoms to show elsewhere in the arm other than the area involving the tendon. This can result from the close proximity of the nerves, tendons, sheaths, and fascia of the forearm to the site of inflammation.



De Quervain's Causes, Symptoms and Diagnosis

The primary symptom of de Quervains tendonitis is pain at the base of the thumb near the wrist. The pain can be sudden and sharp or increase on a gradual basis with use of the thumb or hand. de Quervains is almost always associated with tenderness and swelling of the styloid process of radius bone. Pain can radiate into the forearm and thumb and you may feel a "snapping" sensation when the thumb is moved.

De Quervain's tendonitis was initially common in new mothers who hyper-extended their thumbs while holding the head of their babies. *Further to this, new mothers are particulary susceptible due to hormone related tendon swelling. *Females are ten times more likely to suffer from this condition than males, and occurs most often in individuals between the ages of 30 and 50. Activities that involve movements similar to hammering are suspected of increasing the risk of contracting this condition.

*source: Canberra Hand Centre June, 2019.

de Quervains tenosynovitis is the thickening and inflammation of the sheath containing the tendons of the inner wrist and thumb area (extensor pollicis brevis and abductor pollicis longus tendons). de Quervain's Tendonitis results from inflammation or constriction of the tendons of the muscles of the thumb at the point where they pass into the wrist. In many cases both tenosynovitis and tendonitis occur, a condition known as tendinopathy.

Diagnosis of this condition is based on the location of pain, decreased hand function, and the presence of swelling in the hand.



Surgery

Surgery is not usually necessary, and is typically the option of last resort. A troublesome complication of surgery for de Quervains tenosynovitis is a painful neuroma of the radial nerve as well as increased presence of scar tissue due to the invasive nature of surgery. Controlled exercise several times daily is commonly recommended, especially to prevent frozen shoulder, after the acute inflammation is controlled. Injection within the tendon sheath of a corticosteroid is also sometimes very helpful.

A physician/surgeon will typically start to consider surgery for de Quervains Syndrome if the condition persists after conservative treatment options have been tried for at least 3 months. In most cases, the surgery for de quervain's tenosynovitis is "day surgery", meaning you will most likely not be kept overnight in the hospital after surgery.

Surgery is typically performed using a local anaesthetic with sedation. A small incision is made and the compartment confining the tendon is divided. Once surgery is complete, you will most likely be required to wear a splint for a couple weeks and then undergo stretching/strengthening with the physical therapist later.



De Quervains Syndrome Conservative Treatment Options

The wrist will continue to be inflamed until you allow it to rest from the pain causing activity. Continued damage will cause chronic inflammation, secondary adhesion and general degeneration of the tendon. The tendon sheath itself will probably be injured as the tendon swells, increasing the pain of the condition. When treating the wrist tendon(s), rest the area, apply cold compression for 10-20 minutes at a time for at least 3 times a day. Do this to the injured area for the first day to 3 days of inflammation or longer until the swelling calms down.

If you have tendinitis in your hand or wrist, rest is highly recommended. Avoid activities that cause pain or may have caused the inflammation and begin cold compression treatments as soon as possible.

During the healing process, scar tissue builds on the damaged tendons; this scar tissue can cause the tendon to thicken, decreasing the area in tight spaces (such as the wrist), increasing the chance of nerve impingement. Nerve impingement in the wrist is basically what Carpal Tunnel Syndrome describes.

In addition, know that scar tissue attaches to everything. It can bind tendons, ligaments, muscles, bone and even skin together wherever it grows. Inflexible scar tissue will limit movement of your soft tissue very quickly. Tendons and muscles that were once elastic are now constrained - if you stretch it too far it will start to rip, causing spikes of pain. As a result, movement of the entire joint is limited, making it difficult to flex your hand and/or wrist or even grasp objects. At the very least, scar tissue leaves a tendon weaker than a healthy tendon, leaving injury at greater risk of further deterioration and possible tearing.

The trick to any tendon injury is getting it to heal with minimal scar tissue formation and with as much realignment of tendon fibers as possible. To achieve this, your doctor will most likely recommend up to 6 months of conservative treatments. Even with optimum healing there is always less elasticity in a previously injured tendon. The trick is to make sure you heal it the best you can, that way your chance of re-injury down the road is much lower than average - which is well over 50%.

Once the inflammation of your tendinitis has been reduced through use of a Cold Compress or Ice Pack, nourishing and strengthening of the hand/wrist tendons, muscles and surrounding area is recommended - this includes our recommendation of stretching and home treatments using the Wrist T•Shellz Wrap®. Talk to your doctor or medical professional to find out which exercises are appropriate for your situation.

The Wrist T•Shellz Wrap® may be used after the acute swelling has improved; the T•Shellz Wrap® will stimulate blood flow in the local area, while also warming up the tissue. It is known that warmed tissue will experience a larger range of motion and increased extensibility and this is exactly what you want when you are trying to recover from a soft tissue injury. Increased extensibility and flexibilty in soft tissue means it is less likely to strain or tear further during activity, and less re-injury during this period means less setbacks during healing. Less re-injury helps minimize the build up of scar tissue around the tendon during the healing process, while also reducing the risk and severity of overcompensation pain and secondary injuries. Basically, the value of a faster recovery is often underestimated, as the impact of chronic injuries can quickly spiral out of control.

Why Wrist Tendonitis Can Persist

Often when a tendon injury occurs, the injured area is rested a bit, a pain killer is taken and we continue on with our normal activities. If the strain was minor, the body may be able to heal the tendon fibers normally. Unfortunately, this is not the usual result because the injured tendon is being used instead of rested. Because of the stress on the tendon, the body heals the injured fibers by binding them together with fibrotic adhesions or scar tissue. This is done in an attempt to prevent further damage to the injured area. It is a normal protective response of the body, but buildup of scar tissue can and does become a big problem over the long term.

Scar tissue buildup is one of the main reasons we advocate the use of a T•Shellz Wrap® over the long term once the swelling is down. Much of the pain may have disappeared with the swelling, but that does not mean your tendonitis has healed. The trick is to continue boosting blood flow to the area on a daily basis, helping keep tissues in the area flexible and less likely to strain while your tendon(s) continue to build up strength.

tshellz Wrist coverage carpal tunnel

A General Breakdown of Home Conservative Treatment Options

  • Rest - This is important for initial recovery; rest and elevation will help reduce pain, swelling and inflammation in the early stages of injury. This can be difficult when you have to carry on with daily activities, but resting and elevating your wrist whenever you can is recommended. During your recovery you will probably have to modify or avoid the activities that put stress on the wrist until your pain and inflammation settle. However, too much rest can also be harmful to such injuries because immobility can eventually cause stiffening in the joints. This is why rest should be used when reducing initial pain and swelling, but should not be considered for more long-term conservative treatment.
  • Avoid Activities that Caused Your Injury - While resting your wrist, it's also important to avoid all activities that may have caused the problem (especially any strenuous or repetitive wrist/forearm/finger movement). Continuing on with regular activities can increase the severity of an injury, turning a mild to moderate case of tissue damage into a downward spiral of worsening damage that may eventually severely impact your life. Also, trying to 'work around' your injury will eventually give rise to over-compensation injuries in other areas of your body.
  • Use a Cold Compress or Ice Pack for Inflammation - Cold is very effective at reducing pain and swelling - use at the onset of the injury and during flareups. Immediate pain relief and reduced inflammation can also relieve some of the pressure that's being placed on your wrist soft tissue and stop your injury from getting worse.
  • Use a Wrist T•Shellz Wrap® (Circulatory Boost) Once Swelling is Down - After inflammation and/or swelling has been reduced, you can use your own blood flow to maximize your rehabilitation. Improved blood flow to the forearm and wrist in most cases will help improve recovery time while improving overall health of tissue in the area. Promoting blood flow and heat to the treatment area will help to minimize the growth of scar tissue, increase flexibility and thus help combat atrophy.
  • Rehabilitative Stretching under supervision of a PT or doctor. The intent of this is to provide you with increased range of motion, pain relief and strengthening of the surrounding tissue of the wrist. Doctors or surgeons typically won't perform a surgery until they feel that their patient has put effort into treating their injury with conservative treatment methods. This may include up to 4 to 6 months of visits to a PT clinic. If you haven't experienced any improvement in your condition during that time, surgery may be considered.
  • Stretching - Stretching your joint in PT and at home will help you to regain your range of motion much faster than not stretching at all. Stretching in many ways is key maintaining good Range of Motion (ROM) in your joint, and stretching can be made much easier with use of a Wrist T•Shellz Wrap® before to warm up tissue, and a Cold Compress or Ice Pack treatment after to prevent any return of swelling and inflammation.

Conservative Treatment Tools Our Clients Have Used to Help
Limit Damage & Boost The Body's Soft Tissue Repair Process at Home
(What We Recommend to Assist in Recovery from Your Tendon Injury at Home:)

  • A Cold Compress or Ice Pack to reduce inflammation wherever there is pain and/or swelling (as soon as possible).
  • A TShellz Wrap to increase blood-flow to the treatment area (Circulatory Boost).
  • MendMeShop Arnica Pain Cream for temporary relief of pain due to sore muscles and joints.
  • An Exercise & Stretching Plan to prevent muscle atrophy and shortened tendons in the leg. A proper plan will increase elasticity and strengthen the muscles and tendons in the ankle, calf, knee, and upper leg.

Conservative treatment tools just like these have been used successfully by thousands of tendonitis sufferers - just like you.




T•Shellz Wrap® = Enhanced Blood Flow in the Treatment Area

These tools are what you need for rapid healing. These are the tools that top professional athletes use to treat their injuries every single day. And just like these athletes, you can treat yourself at home.

If you are suffering from any form of tendinopathy or you're recovering from soft tissue surgery, you can heal quickly if you treat your injury correctly. That means using the right therapies every single day.

With regular use of the TShellz Wrap:

  • Your pain will be reduced*.
  • Due to increased blood flow, soft tissue in the treatment area will be expected to recover at an accelerated rate with reduced potential for re-injury*.
  • Tissue in the treated area should experience a larger range of motion and increased extensibility of collagen tissue* due to the heat effect on soft tissue. This should translate into a reduced rate of re-injury occurrence as soft tissue is known to lengthen and become more flexible when exposed to warm temperature. (*Chapter 9 of "Therapeutic Heat and Cold", 4th edition. (amazon.com link - Ed. Justus F. Lehmann, M.D., Williams, and Wilkin)

We believe the use of T•Shellz Wraps® for boosting blood flow to soft tissue in the area of application is one of the most under-utilized home treatment options available on the market today. We have client after client that have tried many options out there and have been amazed at how effective and fast the TShellz Wrap treatment can relieve pain and increase blood flow in the treatment area.


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We believe the use of T•Shellz Wraps® for boosting blood flow to in the area of application is one of the most under-utilized home treatment options available on the market today. We have client after client that have tried many options out there and have been amazed at how effective and fast the TShellz Wrap treatment can relieve pain and increase blood flow in the treatment area.

With regular use of the TShellz Wrap:

  • Your pain will be reduced.
  • With increased blood flow, soft tissue in the area will most likely recover at an accelerated rate*.
  • Due to increased warmth in soft tissue, the corresponding joint will have a larger range of motion and increased extensibility of collagen tissue*. This should translate into a reduced rate of injury occurrance as soft tissue becomes more flexible.
    (*Chapter 9 of "Therapeutic Heat and Cold", 4th edition. (amazon.com link - Ed. Justus F. Lehmann, M.D., Williams, and Wilkin)

Attach the T•Shellz Wrap®, plug it in and let the Energy Pad do the work!

*Know that every personal soft tissue injury is unique and the TShellz Wrap may not work for everyone. This is why we offer a 60-day money back return on all our TShellz Wrap devices.


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During your recovery, you will probably have to modify and/or eliminate any activities that cause pain or discomfort at the location of your soft tissue injury until the pain and inflammation settle. Always consult your doctor and/or Physical Therapist before using any of our outstanding products, to make sure they are right for you and your condition. The more diligent you are with your treatment and rehabilitation, the faster you will see successful results!


 
 

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