• Suyi the physio

Gamer's or Mother's Thumb: DeQuervain's Tenosynovitis

Updated: Jul 1

DeQuervain’s Tenosynovitis aka. Gamer’s Thumb or Mother’s Thumb is a wrist condition found in 1.3% of women and 0.5% of men.



Overuse of the thumb causes thickening of the APL (Abductor Pollicis Longus) and EPB (Extensor Pollicis Brevis) tendon sheath leading to irritation of these muscles.


Common Factors

  • Caring for a newborn

  • New, larger smartphone

  • Long hours at the computer

  • Long hours gaming


Signs and Symptoms

  • Pain at the thumb side of the wrist

  • Palpable tenderness and swelling

  • Difficulty gripping objects i.e. holding a pen or making a fist

  • Inability to twist i.e. open jars or turn door knobs

  • Weakness with wrist deviation i.e. pouring water out of a kettle


Diagnosis

After a full history is taken, an assessment of the thumb and wrist region is completed. This includes observing active movements, passive movements, strength testing and palpation of the tendons and bony prominences. Your therapist may use Finklestein’s Test to confirm the diagnosis.

doi: 10.31128/AJGP-07-19-5018


The diagnosis can be further investigated under ultrasound.



Physiotherapy Treatment

Your physiotherapist can give you strategies on how to avoid further injury as well as how to soothe the pain. This often involves avoiding twisting, lifting and gripping in the first few weeks and gradually reintroducing these movements when the tissues have settled down.


Manual therapy

Dry needling and soft tissue massage of the surrounding areas can help relieve symptoms.


Exercise

Tendon strengthening exercises should commence as soon as possible. Isometric exercises can reduce pain immediately but graduated eccentric loading with resistance is key to tendon recovery. Small elastic bands are a great start for strengthening exercises and are a handy tool to have with you in the first 2-4 weeks. It’s important to note that stretching is not recommended, tendon gliding is prefered.




doi: 10.31128/AJGP-07-19-5018


Support

Kinesio-taping or strapping is often used in physiotherapy management as a temporary support, it can give proprioceptive feedback to avoid further injury (4). A brace with metal or plastic is also commonly advised if long-term splinting is required (3). A thermoplastic splint can be custom made in hand-therapy clinics (2).


Medications

NSAIDs (Non-steroidal anti-inflammatories) may give temporary relief.


Non-Conservative Management

In the case that conservative management does not produce improvement in symptoms after 3-6 months, corticosteroid injections are deemed by many researchers as adequate treatment for this condition. Side effects such as bruising and pain should be monitored and the injection should be followed up with splinting and specific exercises to strengthen the area of muscles and joints.


Surgery can be done to decompress the tendon sheath followed by further splinting if the condition isn’t resolved in 3-6 months of conservative treatment.


Prognosis

Mild cases of DeQuervain’s Tenosynovitis can resolve within 2-6 weeks while severe cases can take months to resolve. The best thing to do is to get a full assessment early on to learn more about what may be triggering the injury and to start strengthening as soon as possible.

Book in with one of our physiotherapists for a full physical assessment, treatment and guided return to normal activity.


References

  • Allbrook, V. (2019). “The Side of my Wrist Hurts'': DeQuervain’s Tenosynovitis. Australian Journal of General Practice, 48. 11.

  • Patel, K. R., Tadisina, K. K., & Gonzalez, M. H. (2013). De Quervain's Disease. Eplasty, 13, ic52.

  • Stahl S, Vida D, Meisner C, et al. Systematic review and meta-analysis on the work related cause of De Quervain tenosynovitis: A critical appraisal of its recognition as an occupational disease. Plast Reconstr Surg 2013:132(6):1479–91. doi: 10.1097/01.prs.0000434409. 32594.1b.

  • Image: https://theclimbingdoctor.com/thumb-sided-wrist-pain-in-climbers-2/


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