Thumb Pain - De Quervain’s Tenosynovitis

De Quervain’s tenosynovitis is a painful condition that affects the wrist and thumb. It is classically considered an overuse injury and has many names such as gamer’s thumb, texting thumb, and mommy thumb. It has also been correlated with autoimmune diseases such as rheumatoid arthritis, so perhaps there is a nutritional component. Repetitive housework may contribute such as chopping vegetables, cleaning dishes, vacuuming, and gardening/weeding. It’s also suggested that use of a computer mouse, using a trackball, typing, golf, bowling, fly-fishing, sewing, and piano playing may be the cause. 

It is tested clinically using the Finkelstein test. You grasp your thumb with the other fingers and tilt the hand down like so:

Either tendons, the sheath around the tendon, or the retinaculum can be affected. The tendons involved are the abductor pollicis longus and the extensor pollicis brevis. Picture hitch-hiking, that’s basically what these muscles do with the thumb. 

How do we address this? 

We like to use the D2R2 method. 

D1: Desensitize it. That means massage, cupping, scraping, or any other tool that makes it feel better. 

D2: Decongest. This means using the pump action of the muscles to evacuate swelling. 

R1: Reperfuse. Similar to decongest, this means using the muscle in a pain free manner to get new blood to the area. 

R2: Restore. This means restoring what’s missing. That could be strength, range of motion, or general function in this area. 

Below is an example of me doing some desensitization on the forearms for a golfer’s or tennis elbow. You can hit any area that is tender, the same principles apply. 

Here are some other exercises you can try. Just make sure it is pain free.

Important to note: If pain does not resolve within a few weeks, have it looked at by a professional. There is a bone in the wrist called the Scaphoid which can commonly fracture. This is usually accompanied with some bruising, but not always. If you’ve had a fall on the wrist or some blunt force to the area, it would be wise to see a physician first to rule this out. Scaphoid fractures can lead to avascular necrosis (the bone dies). 

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