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| <div class="noeditbox">Welcome to [[ Vrije Universiteit Brussel Evidence-based Practice Project| Vrije Universiteit Brussel's Evidence-based Practice project]]. This is a wiki created by and for the students in the Rehabilitation Sciences and Physiotherapy program of the Vrije Universiteit Brussel, Brussels, Belgium. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!</div> <div class="editorbox"> | | <div class="noeditbox">Welcome to [[ Texas State University Evidence-based Practice Project| Texas State University's Evidence-based Practice project space]]. This is a wiki created by and for the students in the Doctor of Physical Therapy program at Texas State University - San Marcos. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!</div> <div class="editorbox"> |
| '''Original Editor '''- [[User:Elizabeth Dallas|Elizabeth Dallas]], [[User:Boris Alexandra|Boris Alexandra]] | | '''Original Editors''' |
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| '''Lead Editors''' - Your name will be added here if you are a lead editor on this page. [[Physiopedia:Editors|Read more.]] | | '''Lead Editors''' - Your name will be added here if you are a lead editor on this page. [[Physiopedia:Editors|Read more.]] |
| </div> | | </div> |
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| == Search Strategy == | | == Search Strategy == |
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| Databases: Pubmed, ISI Web of Knowledge, Internet. <br>Keywords: De Quervain’s syndrome, tenosynovitis and physitherapy.<br>
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| == Clinically Relevant Anatomy<br> ==
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| De Quervain's tenosynovitis involves the abductor pollicis longus and the extensor pollicis brevis tendons.
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| A tendon is a fibrous cord that joins muscle to bone or muscle to muscle, made out of collagen.
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| <u>'''M. extensor pollicis brevis (EPB)'''</u> [2]
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| *origin: ½ dorsal side of the radius, the membrana interossea
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| *insertion: base of the proximal phalanx of the thumb
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| *function: - wrist joint: radial abduction<br> - thumb: extension
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| *innervations: N. radialis
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| *artery: A. interossea posterior
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| <br>
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| <u>'''M. abductor pollicis longus (APL)'''</u> [2]
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| *origin: dorsal side of the radius and the ulna, the membrana interossea
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| *insertion: base of ossis metacarpi I
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| *function: - wrist joint: radial abduction<br> - thumb: abduction
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| *innervations: N. radialis
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| *artery: A. interossea posterior
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| The retinaculum mm. extensorum is a strong, fibrous structure that holds all the wrist extensors into place. I’is located on the dorsal side of the wrist. [2]<br>
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| == Definition/Description == | | == Definition/Description == |
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| De Quervain’s tenosynovitis is an inflammation of the tendons of m. extensor pollicis brevis (EPB) and the m. abductor pollicis longus (APL). These muscles are located on the dorsal side of the forearm and go to the lateral side of the thumb through a fibrous-osseous tunnel made of the processus styloideus radii and the retinaculum mm. extensorum. [1] [2] [3]
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| == Epidemiology /Etiology == | | == Epidemiology/Etiology == |
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| It’s common in sports like golf, bowling, tennis, mountain bike and it includes mothers of young children, computer keyboards operators, engine drivers,… .
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| It’s caused by repetitive use of the thumb in combination with radial deviation of the wrist. (pinching, wringing, lifting, grasping, gardening, knitting). In this position the tendons of the EPB and the APL are pressed to the processus styloideus and when the movement is repeated frequently it can cause irritation of the tendons by friction. The tendons swell, the tunnel becomes too small. [1] [3] [4] It is often diagnosed in patients between 30-50 years. De Quervain syndrome is 10 times more frequent in women than men.<ref>Louis Patry, Michel Rossignol; Guide to the diagnosis of work- related musculoskeletal Disorders; Edition Multimonde, 1998, pag 1</ref>
| | == Characteristics/Clinical Presentation == |
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| <br>In the technology age is has been nicknamed “Blackberry Thumb”<ref name="Wikipedia">Wikipedia. De Quervain syndrome. www.en.wikipedia.org/wiki/DeQuervain's_syndrome (accessed 13 Dec 2009)</ref><br> | | add text here <br> |
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| == Clinical Presentation ==
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| DeQuervains occurs in women 8-10 times more often than men. <ref name="web MD">What is de Quervain's Disease? www.webmd.com/rheumatoid-arthritis/de-quervains-disease (accessed 15 Dec 2009)</ref>The condition can be sudden or gradual. Presents most commonly with pain, swelling and tenderness on the radial side of the wrist at the base of the thumb (first dorsal compartment) as well in rest as in radial deviating of the wrist. Abduction of the thumb is also painful. The pain can radiate into the forearm and distally into the thumb. [3] [4] Symptoms increase with pinching, grasping, and gripping activities. New mothers are prone to this due to child care tasks with lifting, holding and feeding placing the hand in awkward positions; as well as hormonal changes. <ref name="hand">assh.org/Public/HandConditions/Pages/deQuervain'sTendonitis.aspx (accessed 13 Dec 2009)</ref>
| | == Differential Diagnosis == |
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| '''<u><br></u>'''
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| == Differential Diagnosis<br> == | | == Outcome Measures == |
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| 1. Osteoarthritis of the first CMC joint<ref name="Wikipedia" /><ref name="Wheeless">DeQuervain's Disease - Wheeless' Textbook of Orthopaedics www.wheelssonline.com/ortho/dequervains_disease (accessed 13 Dec 2009)</ref><br>2. Intersection syndrome – pain will be more towards the middle of the back of the forearm and about 2-3 inches below the wrist<ref name="Wikipedia" /><ref name="Wheeless" /><br>3. Wartenberg’s Syndrome - isolated neuritis of the superficial radial nerve, can be caused by tight jewelry<ref name="Wikipedia" /><ref name="Wheeless" /><br><br>
| | add links to outcome measures here (also see [[Outcome Measures|Outcome Measures Database]]) |
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| == Diagnostic Procedures ==
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| <u>'''Symptoms <ref>Anderson M & Tichenor CJ. A Patient with de Quervain's Tenosynovitis: A Case Report Using an Australian Approach to Manual Therapy. Physical Therapy. 1994;74(4):314-326</ref>'''</u><br>
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| *Pain, tenderness and swelling at the base of the thumb.
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| *Pain can also radiate proximally into the forearm and distally into the thumb.
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| *Difficulty of movement of the thumb and wrist with activities such as grasping, pinching and crepitus (creaking sound).<ref>Anderson M & Tichenor CJ. A Patient with de Quervain's Tenosynovitis: A Case Report Using an Australian Approach to Manual Therapy. Physical Therapy. 1994;74(4):314-326</ref>
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| [http://www.physio-pedia.com/index.php5?title=Finkelstein_Test <u>'''Finkelstein-test'''</u> ] | |
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| It’s a pain provocation test.[3] [4]
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| == Examination == | | == Examination == |
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| [http://www.physio-pedia.com/index.php5?title=Finkelstein_Test Finkelstein test ]
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| The patient has to make an thumb adduction or an clenched fist in combination with an ulnair deviation. The patient feels pain on the radial site of the wrist around the processus styloideus.<br><br>
| | == Medical Management <br> == |
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| == Medical Management (current best evidence) ==
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| Surgery is indicated if conservative therapy doesn’t help to improve the symptoms and complains of the patient. It’s also indicated when the patient relapses. [3] [4]
| | == Physical Therapy Management <br> == |
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| Surgery: <br>The sheath of the first dorsal compartment is opened longitudinally for decompression.<br>
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| == Physical Therapy Management (current best evidence) ==
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| The goals are to decrease the pain and the imflammation
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| <u>Concervative therapy consists of</u>: [3] [4]<br>- Rest by using an splint for the thumb and wrist during 6weeks, activity modification<br>- Ice or cold packs<br>- Use of Non-Steroidal Anti-Inflammatory Drugs (NAID’s): oral medication, phonophoresis or inotophoresis<br>- corticosteroid injections<br>
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| Exercise is not practiced, because it can increase the pain and irritation of the tendons. There is not enough information about the benefit of exercise on the quervain's disease.[1] [4]<br>
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| == Key Research == | | == Key Research == |
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| add links and reviews of high quality evidence here (case studies should be added on new pages using the [[Template:Case Study|case study template]])<br> | | add links and reviews of high quality evidence here (case studies should be added on new pages using the [[Template:Case Study|case study template]])<br> |
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| == Resources <br> == | | == Resources <br> == |
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| - KANEKO, S., TAKASAKI, H., MAY, S., ‘Application of Mechanical Diagnosis and Therapy to a Patient Diagnosed with de Quervain’s Disease: A Case Study’, Journal of hand therapy, 2009.
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| - KNOBLOCH, K., GOHRITZ, A., SPIES, M., VOGT, M.P., ‘Neovascularisation in de Quervain’s disease of the wrist: novel combined therapy using sclerosing therapy with polidocanol and eccentric training of the forearms and wrists—a pilot report’, Springer, 2008.
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| - FOURNIER, K., BOURBONNAIS, D., BRAVO, G., ARSENAULT, J., HARRIS, P., GRAVEL, D., ‘Reliability and Validity of Pinch and Thumb Strength Measurements in de Quervain’s Disease’, Journal of hand therapy, 2006.
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| - ANDERSON, M., TICHENOR, C.J., ‘A Patient With De Quervain's Tenosynovitis: A Case Report Using an Australian Approach to Manual Therapy’, Physical therapy, 1994, nr 4, vol 74, p. 314 – 326.
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| - http://www.medicinenet.com/de_quervains_tenosynovitis/article.htm<br>
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| == Clinical Bottom Line == | | == Clinical Bottom Line == |
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| == Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) == | | == Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) == |
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| | see tutorial on [[Adding PubMed Feed|Adding PubMed Feed]] |
| <div class="researchbox"> | | <div class="researchbox"> |
| <rss>http://eutils.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=1nikJOfn1NVSyAePQ--FTd4TUttaJMgxF_8IrtH5abbU4kuQtO|charset=UTF-8|short|max=10</rss> | | <rss>Feed goes here!!|charset=UTF-8|short|max=10</rss> |
| </div> | | </div> |
| == References == | | == References == |
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| References will automatically be added here, see [[Adding References|adding references tutorial]].
| | see [[Adding References|adding references tutorial]]. |
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| <references />
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| - Articles: <br>[1] BACKSTROM, K.M., ‘Mobilization With Movement as an Adjunct Intervention in a Patient With Complicated De Quervain’s Tenosynovitis: A Case Report’, Journal of orthopaedic & sports physical therapy, 2002, vol 32, p. 86 -97.
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| - Books:<br>[2] SCHUNKE, M., SCHULTE, E., SCHUMACHER, U., VOLL, M., WESKER, K., Prometheus, Bohn Stafleu van Loghum, Houten, 2005.<br>[3] MEEUSEN, R., Praktijkgids pols- en handletsels, Kluwer editorial, Diegem, 1999.<br>[4] VAN DONGEN, L.M., PILON, J.H.J., Handboek voor handrevalidatie theorie en praktijk, Bohn Stafleu van Loghum, Houten/Mechelen, 2002.<br>
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| [[Category:Vrije_Universiteit_Brussel_Project]] [[Category:Articles]] [[Category:Assessment]] [[Category:EIM_Residency_Project]] [[Category:Hand]] [[Category:Musculoskeletal/Orthopaedics]] [[Category:Special_Tests]] | | [[Category:Texas_State_University_EBP_Project]] |
