A special wrapping technique is used to reduce pain caused by de Quervain’s Syndrome.

De Quervain’s syndrome is named after Swiss surgeon Dr. Fritz de Quervain, who first identified it in 1895. It is also known as de Quervain’s tendonitis, de Quervain’s stenosing tenosynovitis, mother’s wrist or mommy thumb. In the past, this condition was also called “washer woman’s syndrome.”

De Quervain’s tendonitis is caused by an inflammation of the tendons located on the thumb side of the wrist. These tendons, which are associated with the two muscles that allow you to move your thumb away from your hand, run side-by-side from your forearm to your thumb inside membranes called synovial sheaths. When healthy, the tendons glide smoothly inside the sheaths. However, if the tendons become inflamed or the synovial sheath thickens, this restricts movement of the tendons and produces pain.

De Quervain’s is more common in women than in men, and almost 50% of new mothers experience this condition. It has a tendency to develop during pregnancy, when fluid may be retained. It may also develop during menopause.

This condition is also common to people who use their hands in repetitive motions, such as constant gripping, forcefully bending the wrist, placing the wrist in awkward positions, or engaging in lifting or pinching activities. It can also be caused by direct trauma or sudden incorrect lifting, and it is sometimes associated with conditions such as diabetes, rheumatoid arthritis and hypothyroidism.

While it is most often linked with over-use injuries, the cause of de Quervains remains idiopathic (unknown).

When you have thumb or wrist pain, it is important to see a doctor to rule out other conditions such as a fracture, osteoarthritis, intersection syndrome, Wartenberg’s syndrome or carpal tunnel syndrome.

Signs and symptoms
The most common complaint of de Quervain’s is pain and swelling near the base of the thumb or on top of the thumb. Sometimes the pain can spread further into the wrist and forearm.

The pain may appear suddenly or may increase gradually over time. Moving the thumb and wrist may aggravate the pain. Listed below are some signs of de Quervain’s:
• Pain and swelling near the base of the thumb.
• Tenderness above the wrist when touched.
• Difficulty with gripping, pinching, squeezing or moving the wrist from  side to side, such as when waving.
• Problems with lifting or carrying a baby or an object.
• Restriction or “sticking” sensation in the thumb or wrist with movement.

Consult your doctor if you have any of these signs. The doctor will perform a couple of tests in the office to confirm this diagnosis. X-rays or other advanced tests are not usually needed.

Preventing de Quervain’s
The following are ways to prevent de Quervain’s:
• Avoid repetitive motions such as those performed during prolonged gardening, especially weeding and pruning.
• Do not perform constant motions such as chopping, sawing, knitting, cleaning, sports motions or  texting without sufficient rest periods or stretches.
• If you are a new mother, during activities such as lifting the baby, the baby carrier or the baby bottle, avoid placing your thumb and index finger in the “L” shaped position. 
• If the symptoms start, avoid or limit the activity that aggravates your pain.  Apply a cold pack for 5-15 minutes frequently through the day.

Treatment for de Quervain’s
Anti-inflammatory drugs. Your doctor may prescribe an anti-inflammatory
drug such as ibuprofen. In some instances, the doctor may recommend a steroid injection. In most cases, occupational therapy should be tried before resorting to an injection.

Occupational therapy. A hand therapist will conduct a full evaluation and may then provide one or more the following:
• A custom-fitted orthosis (brace) that will rest your thumb/wrist and help
   reduce the inflammation.
• Deep tissue massage of your thumb/wrist.
• Myofascial release techniques (gentle stretching).
• Ultrasound massage.
• As the pain decreases, therapeutic exercises to stretch and strengthen the area.
• An ergonomic assessment and training to prevent further damage, along with recommendations for optimal ways for you to continue your activities of daily living.
• Advice to new mothers on how to lift their babies, the baby carrier, or baby bottle to prevent this condition.

To receive occupational therapy, you will need a prescription from your doctor. For occupational therapy at Phelps, call 914-366-3700 to schedule an appointment.

Anjum Lone, OTR/L, CHT, chief of the department of occupational therapy at Phelps, is an occupational therapist and certified hand therapist.