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Effective Treatments for New Mothers with De Quervain's Tenosynovitis: A Comprehensive Guide

Learn about the most effective treatments for new mothers diagnosed with De Quervain's tenosynovitis, including nonoperative options, steroid injections, splinting, and surgical release. Explore prevention strategies and rehabilitation exercises to manage this condition.

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Effective Treatments for New Mothers with De Quervain's Tenosynovitis: A Comprehensive Guide

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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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