A case study approach was utilized in this article to demonstrate many of the available medical and occupational therapy modalities to. With overuse, the tendons that normally glide smoothly in the back of the thumbwrist, can become inflamed and thickened, restricting their movement. Dequervains release rehab protocol the surgeon must specify on the referral any specific recommendations or deviations outside this protocol. Although recent research suggests that tendinopathy is a more appropriate term to describe overuse injuries to tendons, we will use the term tendonitis in this document as it is more widely known. It causes pain at the thumb side of your wrist where the base of your thumb meets your forearm. Keep postop dressings intact clinical implications. During this time, the splint can be removed to carry out the following exercises. Inflammation is usually aggravated by repetitive thumb movements and twisting motions of the wrist, causing the tendons of the thumb to rub against their surrounding sheaths. The treating physiotherapist can advise which exercises are most appropriate for the patient and when they should be commenced. The condition makes it painful when a person moves their thumb. To minimize swelling, you must keep yourhand lifted up to shoulder level. The two tendons may actually begin to creak as they move through the constricted tunnel. Keep the arm on your injured side straight during this exercise.
A sheath, or covering, surrounds the tendons that go to your thumb. Physiotherapy if your symptoms do settle, we may then give you some stretching and strengthening exercises to increase your hand function. Press the back of the hand on your injured side with your other hand to help bend your wrist. These muscles are located on the dorsal side of the forearm and go to the lateral side of the thumb through a fibrousosseous tunnel. Dequervains tenosynovitis can be rehabilitated and prevented from reoccurrence well by first understanding the cause of dequer. You may do these exercises when it is not painful to move your hand. It also is associated with pregnancy and rheumatoid disease. A sheath, or covering, surrounds the tendons that go to. The first dorsal compartment at the wrist includes the tendons of the abductor pollicis longus apl and the extensor pollicis brevis epb. When left untreated, pain may spread up the forearm or further down into the wrist and thumb. Hold a can of soup or a hammer handle and gently bend your. Swelling of the tendons, and the tendon sheath, can cause pain and tenderness along the thumb side of the wrist. Touch the tip of your thumb to the tip of your little finger.
This video can help you to diagnose and self manage this condition here is. Nov 23, 2016 dequervain s tenosynovitis can be rehabilitated and prevented from reoccurrence well by first understanding the cause of dequer. Use your other hand to gently stretch your thumb and wrist downward until you feel the stretch on the thumb side of your wrist. As mentioned earlier, new parents often carry and put down their new borns, causing additional strain and stress repeatedly at their wrists and their backs people whose work involves a flicking of their wrists e. This irritation causes the lining around the tendon to swell, changing the shape of the lining and making movement of the tendons difficult. These tendons include the extensor pollicis brevis epb and the abductor pollicis longus apl.
Surgical management physical therapy management of the patient who had a release of the first extensor compartment. Your hand should be in the position used for shaking someones hand. Return to the clinic at week 2 postoperatively for reevaluation and suture removal. You will be given rehabilitation exercises to help. Your doctor or occupational therapist will tell you when you can start these exercises and which ones will work best for you.
Lifting the baby with your wideopen thumbs can easily lead to mommy thumb. Reduce the repetitions back to 510 times every 2 hours if your pain returns. A case study approach was utilized in this article to demonstrate many of the available medical and occupational therapy modalities to treat this condition. The condition develops when the tendons around the base of the thumb become irritated or constricted. Its always important to start your rehabilitation exercises by slowly warming up the injured or aggravated joints. Add wrist strengthening and gentle grip strengthening exercises as your pain allows, and as advised by your therapist. Dequervains tenosynovitis inflammation of the tendons of the thumb. A tendon is a strong band of tissue that attaches muscle to bone. Additionally, pregnant mothers during their last trimester and mothers who nurse have a higher chance of acquiring the condition, for which the cause is unknown. Increase the weights and the repetitions of the previous exercises as you are able. Bakkers postop protocol important instructions following surgery. If you start treatment early, your symptoms should improve within four to six weeks. Please practice handwashing and social distancing, and check out our resources for adapting to these times. After surgery, your forearm andhand will be in a large bandage plaster splint.
You will be told when to start these exercises and which ones will work best for you. The initial treatment is to rest the wrist with a 4 week period of wearing a splint that. Use the following stretches and warm ups to promote blood flow, increase tissue malleability and prepare your joint for more advanced progressions. However, newer research suggests that it is a degeneration of the two tendons making the conditions a tendinosis. Here are some examples of typical rehabilitation exercises for your condition. As mentioned earlier, new parents often carry and put down their new borns, causing additional strain and stress repeatedly at their wrists and their backs. You may do these exercises when the initial pain is gone. To decrease the inflammation of the tendons, avoid repetitive movement of the thumb and gripping movements as much as possible. A manual muscle test is not appropriate until the patient is ready for resistive strengthening exercises, which is at 4 to 6 weeks post op. Start to carry out exercise 3 with full active movement of your wrist off the edge of the table without the assistance of your good hand. The word tendinosis refers to a swelling of the tendons. Here are some examples of exercises for you to try. Continue with the removable custom splint, especially with activities as needed. Rest the tip of your thumb at the base of your fourth finger.
If youre more concerned about prevention, try to work these moves into your routine to build strength and balance in the region. Put your wrist in the sideways position with your thumb up. Splints, ice application, antiinflammatory medication, exercise, and in severe cases, surgery. Next, stretch the hand back by pressing the fingers in a backward direction. Lift your thumb away from your palm so its nearly perpendicular to the forefinger side of your hand. Phase i phase ii phase iii phase iv 02 weeks postop 2 weeks postop 6 weeks postop 12 weeks postop general precautions. The swollen tendons and their coverings rub against the narrow tunnel through which they pass. Physiotherapy department dequervains tenosynovitis. The pain is usually worse when the hand and thumb are in use. Place your hand on a flat surface with your palm facing up. Once you can carry out the stage 1 exercises with no pain, add a small weight and increase the repetitions to 1020 times every 2 hours. Gradually increase the weight of the can or weight you are holding. It is a form of repetitive strain injury which is made worse by sport, or workrelated activities.
Learn simple exercises to help achieve lasting recovery. The result is pain at the base of the thumb and extending into the lower arm. The exercises may be suggested for a condition or for rehabilitation. Put your wrist in the sideways position with your thumb. Continue with range of motion exercises, but not aggressive. The three most common causes of stenosing tenovaginitis appear to stem from repeated active contraction of the muscle moving the tendon, and direct injury. Pain is felt in the wrist and can travel up the forearm.
1247 586 737 953 645 1284 190 282 190 359 291 1398 1094 157 1320 129 1412 1021 1406 936 183 578 1 889 1170 75 256 706 1443 34 712 1361 934 1214 1076 1281 1314 265 684 869 13