hi guys mr. physio here. today we will talk about de quervain's tenosynovitis
and I'm sure I can make you an expert in this symptom with this video
so please watch till the end
as always, let's have a look at the structure first
de quervains tenosynovitis is an inflammation on the sheath of tendons attached on thumbs
there are two muscles involved in this symptom
and it is very important to understand their functions
first one is abductor pollicis longus.
it starts from the middle of the forearm (outside of the forearm)
it goes diagonally across the wrist and attaches at the bottom of your wrist
when it contracts, that will bring your thumb out to the side away from the hand
The other one is extensor pollicis brevis which has a similar course
it starts from here and attaches to the bottom of your thumb
so when this muscle contracts, it will pull the thumb backwards
if you combine those two movements together.. (thumb out to the side and backwards)
please subscribe
it's a thumb up position. but do we do that much? (not really)
we normally keep our thumb inwards.
when you use a computer or clicking mouse or using smartphone like this
it means these muscles are always being stretched out
you can test yourself with two fingers
bring your thumb inwards. does the distance between these two fingers widen or shorten
of course it gets wider so it's always being stretched out.
if you keep using them in a lengthened position, these muscles are likely to get tensed up
once these muscles get tight they will pull the tendon away from the bone
tendons attach your muscles to bones. I think my old subscribers already know what's coming
tendons don't like compression and stretching. tendons act as a spring
they always want to go back to their original length
but if you put a prolonged stretch on them
they tend to lose their elasticity and become tight
plus it's near the protruding bone and tendon problems normally occur around that bony areas
and what's worse is that there's a thick band covering your wrist where tendons go under
if this dumbbell is the bone and this is the retinaculum (band)
and your tendon goes under there
your tendon is normally relaxed like this
it gets stretched out because the muscle pulls it away from the bone
so the tendon touches the band
and if you keep using the muscle (muscle keeps contracting)
moving up and down constantly
it creates a lot of friction and causes inflammation
this is pretty much similar to how you develop tendonitis which I've covered a lot in this channel
but it's not exactly the tendon tissue
it's a thin layer that wraps up the tendon and it's supposed to lubricate and prevent the frictions
but if there is a too much friction, it can get inflamed and sore
another thing about de quervain tenosynovitis is that it is a symptom that many moms develop after giving a birth
why is that? first of all there is this hormone called 'Relaxin'
it is a pregnancy hormone that allows muscles and ligaments to loosen up for labor
you have numerous ligaments in your pelvic area
they need to be stretched out during pregnancy and delivery
but this hormone can affect the whole body and it can last up to five months after giving a birth
so let's think about it. your ligaments' main function is to hold your bones tight.
but if it's loosened, what do you think has to work more instead? Muscles!
your muscles have to work more to support your bones
however your muscles can also get affected and you don't really use much of your muscles during pregnancy
because your other half does most of the chores. Right?
not yours? do some works dude
then you start using your muscles a lot because you need to hold your baby all the time
suddenly your activity level increases, which means your muscles can get overworked and tight
that's why de quervain's tenosynovitis is called mother's thumb
so what's the best treatment option for this symptom?
in fact, the best evidence suggests a combination of injections and the brace
according to this study, you wear a brace for four to six weeks while having injections
but I'm not a big fan of injections
in my experience, many people find it uncomfortable wearing brace for four to six weeks
so the compliance rate is really low. I will show you what I do
first of all, you shouldn't do massage and stretching on the painful tendons
massage here. don't do that.
stretching like this..
not good
because like I said these symptoms have started from compression and stretching
you don't want to add more to it
Instead we will do massage on muscles and lengthening exercises
okay so we're going to work on three parts
the first one is here. that's the actual problematic muscles mentioned earlier
if this is the middle of the forearm, it's a little bit down around there
maybe five to seven centimeters away from the wrist.
you can actually move your thumb in and out or back and forth
so that you can feel these muscles activating
or bring your thumb in while pressing down onto those muscles
normally this movement is painful with de quervain's tenosynovitis
but if you press down onto the right muscles, this can be pain-free
because when you hold onto the muscle this muscle gets relaxed
that will reduce the tension on the tendon
so it doesn't pull the tendon anymore
so when you do that, this will stretch out the tendon. that's why it gets painful
but if you press down onto the muscle
the tension on the tendon goes down. that's why it doesn't get sore
once you have found them, try to massage for about 30 seconds
side to side. that's better.
press down and move side to side
and then you hold onto the muscle
slowly move your thumb in and out like that
within the pain free range
and then back and forth as well
Next, you need to loosen up these parts between your thumb and index finger
there's a muscle attached here that brings your thumb inwards
if your thumb goes in, this will put a stretch on that inflamed area.
so we want to loosen up these muscles so that it doesn't pull your thumb in any more
you can massage like that
and at the back
pinch and pull
pinch the muscle and move side to side as well
if there's a pain on the other side here, do small movements or just massage only
the last one is a pronator muscle. pronation is this movement
the muscle starts from here to there
so if it contracts, that brings forearm inwards
if your forearm rotates inwards, you're likely to bring your thumb in too
when your shoulder rotates in, your whole arm rotates as well
can you see my thumb going in?
and if your forearm rotates in, your thumb does the same.
so we will loosen up this pronator
actually there is another pronator around your wrist
but this is the pronator that actually affects the forearm more
so we will loosen up here (about five centimeter towards the thumb)
press down and go side to side
go across like that for about 30 seconds
press down on to the muscle and rotate your forearm
you can use this kind of tool. any object to apply pressure
it's about five centimeter away from the elbow. just massage
you can push down and move side to side
this is great
you can use the tool here too
press down and massage
and this part too.
massage all around there
done
after massage we're gonna do some lengthening exercises
the principle is the same as tendon rehab
your pain level should be below 4/10 during exercises
you need to build up slowly
you can use the other hand
'Thumb up' position.
push down while resisting with the painful thumb
in this position, your muscle is activated and shortened
from there I'm pushing it down with my other hand
so that this muscle will get stretched out while controlling that stretching force
you can use your palm as well. take your thumb back and push it down
3-4/10 is acceptable but beyond that level is not.
if so, you just hold it. give it a bit of resistance and hold it
5, 10, 20.. build up to 45 seconds
you slowly build up
once you can do this holding exercises (45seconds x 5 times a day without pain)
you can slowly push down (start eccentric exercises = lengthening exercises)
also you need to lengthen this muscle too
this muscle brings your thumb inwards. it shortens and lengthens
so we'll start with that muscle in a shortened position first
push your thumb in first and pull it back with the other hand
Push in and pull back (while resisting with your thumb)
your pain shouldn't get worse
a bit of pain is okay but not too much
or any lasting pain is not good
also your pain should stop when you stop the movement
If your pain lasts even after exercises or massages,
10-20 minutes after stopping these exercises or massages? that's not good.
that means you might have irritated the inflamed tendon
so you don't want to continue the exercises at the same level
or just reduce that range.
if you bring your thumb out this much and pain starts,
just stop about there before you feel the pain
so that's the exercise for that muscle
and the last one is for the pronator. pronator muscle shortens when your thumb rotates inwards.
when your forearm goes the other side, this muscle will be lengthened
so you hold a small weight
put your forearm onto a table
rotate your forearm out to the side so that your palm faces up
when you come back, you have to help with the other hand
go down slowly
come back up
this is also good for golfer's elbow as well
I'm gonna make another video about golfer's elbow which will include this exercise
also you can try something like this
if your shoulder sits forward, that rotates your forearm and thumb inwards
just rotate your arm out to the side like that
don't bring your arms backwards
Just rotate your arms (not extension)
as you rotate, you bring your chest forward
and draw your belly button in towards spine
squeeze between your shoulder blades. as you rotate your arms out
try to breathe into your chest. expand your chest as much as you can
and as you come back, breathe out
if you can tuck your chin in and push your whole head back, that'll be fantastic
as you push your head back with your chin in,
you can activate more of that spinal muscles attached between your shoulder blades and neck
if you feel pain around your neck, you need to do arm movements only
this symptom is very painful and it easily gets irritated
it's very important not to aggravate your symptoms.
I will show you how to make a brace using a straw
this is how it's done starting from the base of your thumb.
it goes all the way down. this straw is a bit hard so there's little gap here
but you should use a soft one so that it can lay down along that muscle and tendon
it can give you a bit of more freedom compared to wrist braces
this might help with the pain but it doesn't really fix the problem. just give it a go
if it's effective, you just use it
but the long-term solution is the massage and the lengthening exercises
so that's it. de quervain's tenosynovitis is also similar to tendon problems
we should take a similar approach as we do for the tendon rehab
massage the actual muscle and don't touch on the actual pain area
don't touch on the tendon. don't compress. don't stretch
of course it is an overuse injury but compression and stretching definitely contribute to this problem.
so we can't do anything with the hormone
but we can do something with that stretching and compression component
you need to loosen up your muscles and lengthen up at the same time
work on the actual root cause of that pain
but the most important thing is not to aggravate your symptoms so try to avoid anything that gives you pain
just try that brace and let me know how you feel
thank you very much I'll see you next time