De Quarvian tenosynovitis

Hi this is Aamir Bhatti,

I have a patient of de quarvian tenosynovitis.

I am using thumb-spica splint, infrared and iontophoresis.

Please send your suggestions.

Hi,

www.emedicine.com/orthoped/topic482.htm

You may consider neck and shoulder muscles tightness before trying to treat wrist. If there is a functional problem at wrist, it may have origin in a upper region.

Relaxing cervical area and neuromobilizations work fine with many of these cases but it may be treated early before structural problems may appear.

Thank you for adding the link.

But unfortunately it is a known case of de quarvian tenosynovitis with pain and tenderness over styloid process of radius, pain with movement of only thumb, no pain with finger movements.

Aamir Bhatti

hi Aamir,

Even it is a known De Quervain syndrome, you may try the previous treatment. If the patient responds to such orientation, it really does not matter that it is called De Quervain if pain free!

:) Hi Aamir...

It is wise to "clear" the neck, but sounds like you have. If there is any doubt, neural tension testing can be done.

But, the specific diagnostic test for DQS is shoulder at 0, elbow at 90 degrees , thumb to ceiling. Touch tip of thumb to 5th digit and deviate ulnarly. Pain is immediate. Problem is accompanied by localized swelling and anatomically, there is adhesion of the tendon sheath to the radius when assessed surgically. Immediate relief is by surgical release of the tendon SHEATH. More conservatively.... splinting and rest, phonophoresis with cortisone or NSAID gel/cream, soft tissue release of associated muscles (not the tendon! - too inflammed). Cortison injections can be helpful if minor but should be done by specialist and minimal repeats.

It is crucial to ensure the patient is really resting... i.e. not taking hand out of splint to do housework for example!

Cheers!

It is Finkelstein test,

Thank you for telling another technique of Finkelstein test.

I am already using all those meaures with NSAID cream.

Thank you for adding

Aamir Bhatti

Surprised and delighted to finally have cause to agree with you Bernard, wether there has been a "confirmed' diagnosis of de Quervain's or not , it is well to remember that every diagnosis is a best guess based on evidence and experience. My own experience is similar in many ways to that of Somasimple. If you don't thoroughly explore the prospect of referred effects then there is no way to know wether the symptoms you describe are referred or not. It is not possible to "clear" the wrist of possible referred events by any examination of the wrist, no matter how compelling.The chances of this group of seemingly localised symptoms being from some mysterious breakdown caused by local positions or movements of the wrist is close to nil.When attempting to verify wether a musculoskeletal pain problem is referred or not it is wise to assume it IS referred, and then attempt to prove it is not , rather than the reverse.
In my own nearly 20 years of treating such things, I cannot recall a single case among thousands that did not have a significant component of referred pain and altered sensation derived from the central spine and associated musculature. Now here's where my approach veers away from those like Somasimple, it is simple, easy to do and WORKS. Mobilise the lower cervical and upper thoracic spinal facet joints. Do it thoroughly, be determined to feel changes to those joints and the quality of movements noticed by you until pain associated is eased in each joint. This may take several minutes or longer in each case. Work with you thumbs, if rests are required take them, but pursue those facet joints within patient tolerance till change occurs. Stretch Brachial dura. You will find a change has taken place to the pain sensations immediately at the wrist . Don't take my word for it , or that of anyone , just try it. (Good on you Bernard.)

Good day all
Pls i want to know other physiotherapeutic management of scoiliosis apart from using braces especially milwaukees brace. thanks very much