Its always important to start your rehabilitation exercises by slowly warming up the injured or aggravated joints. Hold a can of soup or a hammer handle and gently bend your. Keep postop dressings intact clinical implications. The first dorsal compartment at the wrist includes the tendons of the abductor pollicis longus apl and the extensor pollicis brevis epb. Use the following stretches and warm ups to promote blood flow, increase tissue malleability and prepare your joint for more advanced progressions. This video can help you to diagnose and self manage this condition here is. Phase i phase ii phase iii phase iv 02 weeks postop 2 weeks postop 6 weeks postop 12 weeks postop general precautions. A sheath, or covering, surrounds the tendons that go to your thumb. The two tendons may actually begin to creak as they move through the constricted tunnel.
The swollen tendons and their coverings rub against the narrow tunnel through which they pass. Increase the weights and the repetitions of the previous exercises as you are able. Pain is felt in the wrist and can travel up the forearm. Your doctor or occupational therapist will tell you when you can start these exercises and which ones will work best for you.
Touch the tip of your thumb to the tip of your little finger. If you start treatment early, your symptoms should improve within four to six weeks. Learn simple exercises to help achieve lasting recovery. 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. You may do these exercises when the initial pain is gone. A case study approach was utilized in this article to demonstrate many of the available medical and occupational therapy modalities to. 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. The word tendinosis refers to a swelling of the tendons. Use your other hand to gently stretch your thumb and wrist downward until you feel the stretch on the thumb side of your wrist. It also is associated with pregnancy and rheumatoid disease. Lifting the baby with your wideopen thumbs can easily lead to mommy thumb. Here are some examples of exercises for you to try. Department of rehabilitation medicine newyorkpresbyterian. Dequervains release rehab protocol the surgeon must specify on the referral any specific recommendations or deviations outside this protocol.
With overuse, the tendons that normally glide smoothly in the back of the thumbwrist, can become inflamed and thickened, restricting their movement. The condition makes it painful when a person moves their thumb. If youre more concerned about prevention, try to work these moves into your routine to build strength and balance in the region. Lift your thumb away from your palm so its nearly perpendicular to the forefinger side of your hand. Dequervains tenosynovitis can be rehabilitated and prevented from reoccurrence well by first understanding the cause of dequer. Gradually increase the weight of the can or weight you are holding. Add wrist strengthening and gentle grip strengthening exercises as your pain allows, and as advised by your therapist. 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. Dequervains tenosynovitis inflammation of the tendons of the thumb. The treating physiotherapist can advise which exercises are most appropriate for the patient and when they should be commenced. Surgical management physical therapy management of the patient who had a release of the first extensor compartment. Swelling of the tendons, and the tendon sheath, can cause pain and tenderness along the thumb side of the wrist. The result is pain at the base of the thumb and extending into the lower arm.
Reduce the repetitions back to 510 times every 2 hours if your pain returns. Return to the clinic at week 2 postoperatively for reevaluation and suture removal. You will be told when to start these exercises and which ones will work best for you. Continue with the removable custom splint, especially with activities as needed.
Nov 23, 2016 dequervain s tenosynovitis can be rehabilitated and prevented from reoccurrence well by first understanding the cause of dequer. During this time, the splint can be removed to carry out the following exercises. 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. The pain is usually worse when the hand and thumb are in use. Here are some examples of typical rehabilitation exercises for your condition. To minimize swelling, you must keep yourhand lifted up to shoulder level. The three most common causes of stenosing tenovaginitis appear to stem from repeated active contraction of the muscle moving the tendon, and direct injury. A case study approach was utilized in this article to demonstrate many of the available medical and occupational therapy modalities to treat this condition. To decrease the inflammation of the tendons, avoid repetitive movement of the thumb and gripping movements as much as possible.
These muscles are located on the dorsal side of the forearm and go to the lateral side of the thumb through a fibrousosseous tunnel. It causes pain at the thumb side of your wrist where the base of your thumb meets your forearm. Place your hand on a flat surface with your palm facing up. 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. Please practice handwashing and social distancing, and check out our resources for adapting to these times. Press the back of the hand on your injured side with your other hand to help bend your wrist. These tendons include the extensor pollicis brevis epb and the abductor pollicis longus apl.
Continue with range of motion exercises, but not aggressive. Splints, ice application, antiinflammatory medication, exercise, and in severe cases, surgery. Bakkers postop protocol important instructions following surgery. The initial treatment is to rest the wrist with a 4 week period of wearing a splint that. Your hand should be in the position used for shaking someones hand. A sheath, or covering, surrounds the tendons that go to. You may do these exercises when it is not painful to move your hand. A tendon is a strong band of tissue that attaches muscle to bone.
Put your wrist in the sideways position with your thumb up. 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. 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 condition develops when the tendons around the base of the thumb become irritated or constricted. 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.
However, newer research suggests that it is a degeneration of the two tendons making the conditions a tendinosis. Physiotherapy department dequervains tenosynovitis. When left untreated, pain may spread up the forearm or further down into the wrist and thumb. It is a form of repetitive strain injury which is made worse by sport, or workrelated activities. You will be given rehabilitation exercises to help. Keep the arm on your injured side straight during this exercise. This irritation causes the lining around the tendon to swell, changing the shape of the lining and making movement of the tendons difficult. Physiotherapy if your symptoms do settle, we may then give you some stretching and strengthening exercises to increase your hand function. Next, stretch the hand back by pressing the fingers in a backward direction. Put your wrist in the sideways position with your thumb. The exercises may be suggested for a condition or for rehabilitation.