Physiotherapy management & Treatment of De Quervain tenosynovitis

Physiotherapy management & Treatment

Rest, ice and NSAIDs may provide relief and reversal of this condition, especially if it is caught early enough. Splinting with a thumb-spica splint may be necessary to reduce the movement of the wrist and lower joints of the thumb. If these interventions do not work, then a cortisone shot into the irritated area may be the next course of action. Physical therapy may also be used to retrain movements to avoid or change the method of those daily actions that caused the inflammation.
In acute stage
Provide a variety of hand splints to support the thumb and the wrist
Help identify aggravating activities and suggest alternative posture
Massage
cryotherapy (eg, cold packs, ice massage) to reduce the inflammation and edema
ultrasound or electrically charged ions suggest activity modifications
In chronic stage
Thermal modalities
Transverse friction massage
Cold laser treatments are becoming more common with a high success rate for reducing localized swelling of tendons (tendonitis). More and more physical therapy and hand centers are finding this modality to be useful for De Quervain's syndrome.
Splinting
Sensory evaluation
Therapeutic exercises—starting with ROM exercises, and as the patient progresses, adding strengthening exercises
Ergonomic workstation assessment as needed
Educating the patient to either avoid or decrease repetitive hand motions, such as pinching, wringing, turning, twisting or grasping and
A home-exercise program
Surgical Treatment for De Quervain tenosynovitis
Surgery may be recommended if symptoms are severe or do not improve. The goal of surgery is to open the compartment (covering) to make more room for the irritated tendons. The final step, if all other interventions fail, is surgery to release the tendons and provide more space for them to move. Following the surgery physical therapy may still be required to retrain the movements that caused the injury.
Drugs Treatments
Using NSAIDs, such as ibuprofen (Advil, Motrin, others) and naproxen

Complications
Although de Quervain tenosynovitis features a simple tendon entrapment and the treatment is quick and straightforward, complications can be profound and permanent. Careful attention to surgical technique at the initial release is paramount to avoiding complications. Superficial radial nerve injury is the most irksome complication. Sharp injury, traction injury, or adhesions in the scar can cause neuritis in this high-contact area, greatly limiting hand and wrist function. This complication is best avoided through careful blunt dissection of the subcutaneous tissue and gentle traction. Persistent entrapment symptoms are possible if the tendon slips of the abductor pollicis longus are mistaken for the
tendons of the abductor pollicis longus and the extensor pollicis brevis. In such a case, the extensor pollicis brevis tendon may remain entrapped within the septated first dorsal compartment. Should repeat cortisone injections fail to relieve symptoms, careful surgical re-exploration may allow a previously overlooked tendon to be released. Subluxation of released tendons is possible. With wrist flexion and extension, the tendons of a widely released first dorsal compartment snap over the radial styloid. This complication is best avoided by carefully limiting the release to the thickest mid – 2 cm of the first dorsal compartment or by reconstructing a loose roof to the released sheath. Reconstruction of the sheath with a slip of local tissue may relieve symptoms. You may begin to limit your hand and wrist movements to avoid pain from untreated de Quervain's tenosynovitis .