Pinching, Crimping, and Big-Wall Blues: De Quervain’s Tenosynovitis

What is De Quervain’s Tenosynovitis?

De Quervain’s Tenosynovitis is a painful condition that affects the tendons at the base of the radial (thumb) side of the wrist. De Quervain’s Tenosynovitis occurs when the tendons at the base of the wrist become irritated or restricted. This condition is often linked to activities requiring repeated wrist movements or grasping including gardening, tennis, texting, golf, hammering, and rock climbing.

Anatomy of the thumb:

De Quervain’s Tenosynovitis affects two main tendons of the thumb: abductor pollcis longus (APL) and the extensor pollcis brevis (EPB). These tendons assist with moving the thumb away from the index finger and straightening the joints of the thumb. The APL and EPB tendons arise from muscles in the forearm and are encased within a tendon sheath as they pass from the wrist into the hand. The role of the tendon sheath, or synovium, is to provide the tendons with nutrients and reduce friction to allow for easy and smooth movements of the thumb and wrist. De Quervain’s Tenosynovitis occurs when this tendon sheath becomes irritated and inflamed resulting in increased friction and pain with certain thumb and wrist movements.

Signs and symptoms of De Quervain’s Tenosynovitis:

• Pain near the base of the thumb, especially when grasping, lifting objects, or twisting the wrist

• Swelling near the base of the thumb

• Difficulty moving your thumb and wrist, especially during activities involving grasping and pinching movements

• A sticking, catching, or snapping sensation in your thumb while moving it

Diagnosis of De Quervain’s Tenosynovitis:

To determine whether you have De Quervain’s Syndrome, or if your wrist and thumb pain is due to another cause, your physiotherapist will start by asking you a series of questions about your symptoms, function, and activities. From there, your physical therapists will observe your hand for signs of inflammation and assess your range of motion and strength. Your physical therapist may also perform a special test known as the Finkelstein test which involves placing your thumb in your palm, grasping it with your other fingers, and bending your wrist toward your little finger. The test is positive, indicating you may have De Quervain's tenosynovitis if you experience pain during this test. If you believe you may be experiencing wrist pain due to De Quervain’s Tenosynovitis, book an appointment with one of the physiotherapists at Elios Health, located on Main Street in Vancouver, BC, who can help to diagnose your condition and get you started on a treatment plan to reduce your symptoms.

The Finkelstein Test

De Quervain’s and Rock Climbing:

Our wrists and hands take on a variety of positions while rock climbing. The thumb is commonly involved in performing pinch grips. Pinch grips, requiring the coordination of both extrinsic and intrinsic muscles of the hand and thumb, are much more complex than they may seem. There are eight different muscles involved with the movement of the thumb. Depending upon the type of pinch grip, hand/wrist positioning, and direction of force, different muscles, and their associated tendons will have more involvement than others.

When the wrist is positioned in neutral, the major thumb muscles involved in the act of pinching an object are the adductor pollicis and the opponens pollicis muscles, as it pulls our thumb inward toward our palm and toward the rest of our digits. In this position, the abductor pollicis longus and extensor pollicis brevis tendons which are associated with De Quervain’s Syndrome are placed at minimal stress. When grabbing vertical pinches however, the wrist is forced into excessive ulnar deviation, which places extra strain on the APL and EPB tendons as load is applied. In this pinch position, a climber is required to resist downward forces to the thumb as the body moves up to the next hold. Hang boarding or training with this type of vertical pinch grip can also be aggravating to the region. Other potential climbing-related causes of De Quervain’s syndrome include repeated closed crimping, over-engaging the thumb in a three-finger drag position rather than allowing the thumb to relax at the side of the hand, or engaging in multi-pitch or big-wall climbing which places repetitive stress on the thumb while jumaring, hauling, and top-down belaying.

A vertical pinch grip causes excess strain to be placed on the radial (thumb) side of the base of the wrist.

Treatment for De Quervain’s syndrome:

The first phase of treatment for De Quervain’s syndrome is unloading and activity modification. This is especially important during stages of acute pain and inflammation. Take a break from activities that require repetitive movements of the wrist and hand, including texting, typing, playing video games, and climbing in positions that place high stress on the thumb. Ice, and in some cases thumb splints may be indicated during this phase of healing.

The second phase of recovery for De Quervain’s syndrome involves improving mobility of the hand, wrist, and thumb. The physiotherapists at Elios Health can perform a variety of hands-on therapies, stretches, and modalities such as acupuncture and IMS to help improve your mobility. At Elios Health, we will also provide you with instructions for at-home stretches self-massage techniques to help ease your symptoms and accelerate your recovery.

The third phase of treatment involves strengthening. The hand and wrist so that your muscles and tendons can meet the demands of your sports and activities. As climbers themselves, the physiotherapists at Elios Health will teach you various climbing-specific strength exercises that will not only reduce your pain and symptoms but also improve your climbing abilities! Furthermore, our physiotherapists can provide you with climbing and training tips to help you reduce your chance of injury in the future. 

Additional Exercises For the Prevention and Treatment of De Quervain’s Tenosynovitis:

1. Ulnar and radial deviation

2. Wrist flexion and extension

3. Isometric radial deviation

4. Ulnar and radial deviation with dumbbell

5. Hammer Curl

6. Elbow pronation with dumbbell

Original Post by Rachel Rubin-Sarganis

Photo by Len Chong, taken of unknown free soloist on Snake Dike, Yosemite Valley