Ep 41: Thumb Side Wrist Pain: Understand and Treat Thumb Tendonitis Before Surgery Becomes Necessary

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Thumb tendonitis (De Quervain's tenosynovitis) is a common condition affecting tendons on the thumb side of the wrist that requires immediate attention to prevent surgery. Early intervention with custom orthoses, therapeutic techniques, and potentially steroid injections can effectively treat this condition and preserve hand function.

• Two specific tendons involved: extensor pollicis brevis and abductor pollicis longus
• Often accompanied by radiostyloiditis (inflammation at the bony knob at wrist base)
• Diagnosed through several tests, including the Finkelstein maneuver (bending the thumb toward little finger)
• Custom thumb spica orthoses that immobilize the wrist while allowing fingertip use
• Treatment progresses from full immobilization to modified splinting as healing occurs
• Therapeutic interventions include ultrasound, stretching exercises, and cold laser therapy
• Soft tissue mobilization techniques help release adhesions around tendons
• Steroid injections can significantly reduce inflammation when appropriate
• Surgery becomes necessary when conservative treatment fails after prolonged symptoms
• Condition is as common as carpal tunnel syndrome, but requires prompt attention

If you're experiencing thumb-side wrist pain, seek treatment from a hand therapist as soon as possible. The sooner we address this condition, the better your chances are of avoiding surgery.

Chapters

• 0:00 Introduction to Thumb Tendonitis
• 0:40 Testing for De Quervain's Tenosynovitis
• 1:34 Treatment Options and Custom Orthoses
• 2:41 Therapy Techniques and Steroid Injections
• 4:24 Surgery and Prevention Importance

Transcript

Speaker 1: 0:00

Welcome back to the Hand to Shoulder Solution giving pain the middle finger. I'm your host, carl Petito. I'm an occupational therapist and board-certified hand therapist. I specialize in rehab of any orthopedic condition affecting the fingertips through the shoulder. So today let's talk about pain on the thumb side of the wrist, thumb tendonitis. You know this is a very common thing. We use our thumbs for everything and time is of the essence with everything, but especially with the thumb tendonitis, because this quickly easily leads to needing hand surgery. As a hand therapist, I want to help you avoid the need for hand surgery. So the sooner we can get to this the better.

Speaker 1: 0:40

You can see on my thumb, with the tendons that are involved, they pick up. So you know these are used a lot and they are held down against the bone right here by a thick, heavy ligament and that is a friction point. Also here, if you feel your, you follow the base of your thumb down and then there's the bony knob. You can feel that area. If that's tender, that's called radial styloid itis. Itis means inflammation, but this inflamed area of bone and there's also a little fluid sac there that gets inflamed and aggravated with this condition. So these very often both occur at the same time. So let's talk about these tendons. There's two tendons that lift the thumb up. One is this one, extensor pollicis longus, and that travels down around here. That is not involved in this. Okay Now, extensor pollicis brevis. If you bend the tip down and you push up here, that's the tendon right there. That is one of them that is involved in this. So if you bend the tip down and you put your opposite finger just below that knuckle and push up and that hurts a lot right there, that means that you have tendonitis right there. Okay now, abductor pollicis longus, that does this. That tendon goes right here and that's over here. So if you resist that, if you pull your thumb away from your palm a little bit now, you resist that motion and that hurts down here. That's a big one.

Speaker 1: 2:09

The main one is the test called Finkelstein's maneuver, where I have the patient hold their thumb and then we bend it down toward your little finger and if that hurts a lot right there, that is a positive test for the thumb tendonitis. It's called decrevains tenosynovitis All right, so it's a combination of decrevains How's this for alphabet soup Decrevains, tenosynovitis and radiostyloiditis. Isn't that a fun one? So when you do those tests and that's bothering you. You know you. You have to get in, be seen by your health care provider immediately.

Speaker 1: 2:49

There's a lot of things we can do. The sooner I see you, the better I can, more effectively I can save you from needing surgery. So what do we do for this? I will fabricate. I made this on myself, so I fabricate a custom orthosis that goes over the thumb. The tip of the thumb is free because that muscle tendon is not involved. You can still use your fingertips, you can grab things and read a book and fold clothes and still use your hand. And after this starts feeling better, after a patient wears this for some time, I can cut off the forearm piece to free the wrist.

Speaker 1: 3:22

And I'll just give you an example on a different splint, another custom splint, this is a. These are called a thumb spica. So now, now the wrist is free, these are held on by velcro straps. I just removed the straps, so now your wrist is free to move, but it's still securing those tendons and allowing those to rest. So that's a good step down and then, finally, we fully get rid of the splints.

Speaker 1: 3:50

In the meantime, we're also doing ultrasound. We're doing some light stretches, home program educating you to specific stretches to do to help your specific situation. Also, proper timing and technique of heat versus cold and also in the clinic is, you know we're using the cold laser et cetera and some soft tissue techniques where I would pull the skin up a little bit to loosen any adhesions or stuck areas or very slightly stretch the skin on the surface but not aggravate the underlying structures. So there's a lot of tools in the toolbox. Studies have also shown that if you're agreeable to getting a steroid injection, the little bit of steroid right there will also really nip it in the bud and be another great tool to just getting rid of that tendon. That is, the surgery is to go under the skin and cut that strap of material that is grinding on the tendon, that the tendon is sliding on. That's compressing it. And then there's also sheaths around the tendon material here's another item here and the tendon. You can see the blue area. The tendon is wrapped in a sheath and between the sheath and the tendon is some lubricating fluid.

Speaker 1: 5:06

So you know it gets complex and that sometimes that gets a bunch of scar tissue, especially if this has been going on for a long time, and you know if it's been going on for a year or so, you're most likely just going to end up needing the surgery, and the surgery is a relatively basic surgery and the surgeon goes in there and and cleans up the scar tissue. They release those structures I just talked about. So now there's no pressure on the tendon. But if you just started having this condition, you can get in to me and be seen by your hand therapist sooner rather than later. That's the key. Thanks a lot for watching. Thanks for sharing the video. Write, write in with any questions, share your experiences. I want to get people talking about this. It's as common as carpal tunnel syndrome. So many people have this. It has to be taken care of sooner rather than later.