De quervain Tenosynovitis

                       DE  QUERVAIN  TENOSYNOVITIS  

 De  quervain  Tenosynovitis  is a painful  condition  affecting  the  tendons  of   thumb (  the  tendon of extensor pollicis  brevis  and  Abductor pollicis  longus and  the  sheath  covering  them ).

 These  both tendons  are  continuesly  used  in   gripping   ,  writing  and  pinching  activities. 

ETIOLOGY :-  

• The   exact  cause  of it is   unknown. 
• It  may  be  due  to repetitive   activities  of thumb  like  excessive  writing  activities. 
• Now   a  days  the  main  cause  of it  is  excessive  use  of smartphones  and  computer  mouse. 

PATHOGENESIS:-  

Repetitive   Activities 

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Non-Inflammatory  thickening of  synovial sheath 

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Chronic  degeneration  of  tendons and  sheath. 

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Inflammation  of  tendons  and  sheath. 

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Cause  pain and  swelling  around  thumb and  wrist.

CLINICAL  PRESENTATION -

 

•    Patient  have  a  complaint  of  pain around  thumb and on lateral   side  wrist. 
• Patient  complaints  that  his  pain  aggravates  during   writing   ,gripping  and  pinching  activities. 
• The  patient   have  a  swelling   around  the  anatomical  snuff   box.

SPECIAL  TESTS  :-  

FINKELSTEIN  TEST:- 

This  is  most  important  test for  diagnosis  of  de  quervain  Tenosynovitis. 

INVESTIGATION :- 

X  rays is  performed  to  diagnose  any  fracture  which  cause  pain and  swelling. 

DIFFERENTIAL DIAGNOSIS  :-

• Any  bony   Fracture. 
• Osteoarthritis 
• Rheumatoid  arthritis 
• Waternserg's  syndrome 

TREATMENT :-

1  CONSERVATIVE   MANAGEMENT :-

• Avoid  the  pain creating  activities. 
• Thumb and  wrist  stabilising  splints  may  be  used.
• NSAIDS  may  be  used  for  pain  and  Inflammation. 
• Local  injection  of  steroids  can be  used.
  

2.  SURGERY:-

• If  the  condition   not  improves  from conservative   management  then surgery  can be  used  
• By  division  of  appropriate  ratinaculumm  the  condition  may  improve. 

PHYSIOTHERAPY   MANAGEMENT :- 

GOALS:- 

• Pain   relief. 
• Improve  the  functional  activities  of  patient. 

TREATMENT :-

• Cryotherapy. 
• Thermotherapy (TENS  ,US )
• Splinting   of  the  wrist  and  thumb  .
• Appropriate  active and  passive   exercises   to  wrist   and  fingers .
• The    following   exercises   should  perform :-