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Kimberly Reed

"What are the most effective treatments available for new parents, particularly new mothers, who have been diagnosed with De Quervain's tenosynovitis?". Kimberly Reed. Background information.

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Kimberly Reed

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  1. "What are the most effective treatments available for new parents, particularly new mothers, who have been diagnosed with De Quervain's tenosynovitis?" KimberlyReed

  2. Background information • De Quervain’s tenosynovitis – painful swelling of the APL and EPB tendons and their sheaths at the distal radius in the first dorsal compartment. • Dx confirmed with 1) positive Finkelstein’s test and 2) tenderness to percussion over the radial styloid and the first dorsal compartment. • More women than men are afflicted with this condition (4:1).

  3. Possible Causes • Chronic or direct trauma • Presence of a septum • Genetic factors • Infection • Prolactin levels • Mechanical disadvantage for women • Taking care of young children and babies - position of thumb in abduction for extended periods

  4. Characterization of the key findings • Studies comparing steroid injections alone, splinting alone, and steroid injections and splinting • Studies giving a report of cases – women who developed de Quervain’s during pregnancy • Retrospective chart reviews • Dissection of cadavers to determine presence of a septum

  5. Evidence review continued… • Comparing operative findings to published descriptions of anatomy of APL and EPB • Retrospective examination of ultrasonographic findings compared to operative findings in surgery • Randomized prospective study on women who were either pregnant or breast-feeding comparing splinting and cortisone injection

  6. Evidence review continued… • Expert opinion • Literature review • Lack of client-centered perspective evidence • One study found used health status questionnaire • This study was not specific to de Quervain’s

  7. Key findings • Nonoperative treatments mentioned most include rest, splinting, steroid injections • Steroid injections alone appear to be better than combined treatments of splinting and steroid injections • Most of the articles do not promote splinting • Thumb spica splint • Long opponens splint

  8. Key findings continued… • If nonoperative treatments do not work, a surgical release of the first dorsal compartment is performed. • One complication – doctors should thoroughly inspect for the presence of a septum between the two tendons. If they miss it, patient may still have pain. • Multiple tendon slips and septums – complete or incomplete

  9. Key findings continued… • After a surgical release, rehab treatments may consist of splinting, tendon gliding exercises, and scar massage • Necessary to break down scar tissue overlying the sensory branch of the radial nerve

  10. One thing not mentioned in the research? • PREVENTION • Rest the tendons by keeping them out of positions of extreme extension and abduction

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