Diagnosis Explanation:

De Quervain’s Tenosynovitis is an inflammation of the tendons in the wrist at the base of the thumb, caused by repetitive hand motions, gripping, or direct injury. It affects the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons, making thumb and wrist movement painful.

Symptoms:

• Pain and swelling at the base of the thumb, extending into the wrist.
• Difficulty gripping, pinching, or twisting objects (e.g., opening jars, lifting a baby).
• Pain worsens with wrist movement and thumb use.
• Crepitus (grinding sensation) in severe cases.

Specific Work Modifications for:

• If your job involves typing or writing: Use an ergonomic keyboard and mouse, and take frequent breaks.
• If your job requires manual labor: Use wrist braces and avoid repetitive pinching and gripping.
• If your job is desk-based: Keep wrists neutral, adjust desk height, and use adaptive tools if needed.
• Avoid: Repetitive gripping, excessive wrist motion, and prolonged forceful thumb use.

Specific Activity Modifications:

• If you play an instrument or do crafting: Modify technique and use larger-handled tools to reduce thumb strain.
• If you play sports: Avoid racket sports, golf, weightlifting, and activities that require gripping.
• If you knit, garden, or cook: Use ergonomic grips and take frequent breaks.
• Avoid: Repetitive thumb use, gripping-heavy activities, and forceful pinching.

Recommended Supplements:

• Vitamin B6 – 50-100mg daily to support nerve and tendon health.
• Magnesium – 300-400mg daily to relax muscles and improve circulation.
• Omega-3 Fatty Acids – 1000mg daily to reduce inflammation.
• Turmeric (Curcumin) – 500-1000mg daily for pain relief.
• Collagen Peptides – 10g daily to support tendon and ligament repair.

Recommended Nutrition and Hydration:

• Eat Anti-Inflammatory Foods (salmon, leafy greens, turmeric, berries, nuts) to reduce swelling.
• Increase Lean Protein (chicken, fish, tofu, eggs) to support tendon healing.
• Consume Hydrating Foods (cucumber, watermelon, citrus) to maintain tendon flexibility.
• Limit Processed Foods & Sugars to prevent inflammation.
• Hydration: Drink 8-10 cups of water daily to support tendon recovery.

Home Exercise Prescription (Rehabilitation for De Quervain’s Tenosynovitis)

Early Phase (0-2 Weeks, Reducing Pain & Inflammation):

• Wrist Splinting – Wear a thumb spica splint to limit movement and allow healing.
• RICE Protocol – Rest, Ice (15-20 min, 3x/day), Compression, Elevation.
• Passive Thumb Stretch – Use the opposite hand to gently pull the thumb away from the palm, hold 20 seconds, 3x/day.
• Radial Nerve Glide – Extend arm, bend wrist backward, then slowly flex fingers, 10 reps, 2x/day.

Strengthening Phase (2-6 Weeks, Improving Hand Strength & Endurance):

• Thumb Opposition Exercise – Touch thumb to each fingertip, 10 reps, 2x/day.
• Isometric Thumb Press – Press thumb against index finger, hold 5 seconds, repeat 10 reps, 2x/day.
• Finger Extension (Rubber Band Exercise) – Wrap a rubber band around fingers, open hand against resistance, 10 reps, 2x/day.

Advanced Phase (6+ Weeks, Preventing Recurrence & Maintaining Function):

• Wrist Ulnar Deviation (Light Resistance) – Hold a small weight, move wrist side to side, 10 reps, 2x/day.
• Thumb Resistance Exercise – Use a resistance band to strengthen thumb movements, 10 reps, 2x/day.
• Grip Strengthening (Soft Ball Squeeze) – Squeeze a soft ball 5 seconds, repeat 10 reps, 2x/day.

Helpful Books:

1. The Hand and Wrist Pain Solution: Simple Exercises for Relief – Dr. Ross Clifford.
2. Arthritis and Hand Therapy: A Self-Help Guide to Managing Joint Pain – Susan J. Barnhart, PT.

Contact the Key West orthopedic clinic or reach out to Dr. Jason Pirozzolo.