What is de Quarvains?
Radial styloid tenosynovitis other wise known as De Quervains syndrome is a fairly common injury that is caused by repetitive hand or wrist strain due to overuse. It primarily affects women over the age of 50, but can affect people who use their hands frequently. Clinically it is treated very well with acupuncture and conservative therapies such as splinting. Surgery is rarely needed. With acupuncture treatment, patients can expect to see results within 2 treatments.
The tendons of extensor pollicis brevis as well as abductor pollicis longus become inflamed. These tendons connect the wrist and forearm together. The tendons are surrounded by a tenosynovium soft tissue that lines the tendons and joint which allows the tendons to glide with ease. Inflammation of the tenosynovium is called tenosynovitis (itis- for inflammation). When the tenosynovium becomes inflamed the tendons will have a hard time gliding between each other, this results and causes pain. It is not clear why people get
De Quarvains, however it is thought to be due to repetitive stress activities using the thumb.
Symptoms
Symptoms can present as pain or swelling on the side of the thumb and wrist. Pain can spread along the forearm and wrist going up the arm. Some patients notice that symptoms may intensify without treatment.
Diagnoses
Diagnosing de Quarvain’s is fairly simple. The patient is asked to extend their arm out while making a fisth with their thumb inside. Then the patient will bend their wrist downward. A positive test will result in pain shooting down their thumb. This test is called the Finkelstein test.
Conservative treatment includes ceasing activity that causes pain, such as repetitive motion with the thumb. A doctor may even prescribe a splint to prevent usage of the thumb. Over the counter anti inflammatory medications can also be used to help reduce pain and swelling. Surgery is rarely performed.
Acupuncture Protocol
Acupuncture needles will be inserted in the depression between extensor pollicis longis and extensor pollicis brevis (LI5 Yan Xi). As well as the radial end of the transverse crease of the wrist (Lu9 Tai Yuan). Needling into the muscles of extensor carpi radialis longus and brevis (LI 10 Shou San Li) can help release the musculature and bring blood flow towards the surrounding tissues.
Case Study
A 3X year old male patient presenting with pain in his right thumb was seen on 5/16/20. Previously diagnosed with arthritis by his family physician. The patient was treated successfully with acupuncture over the course of 5 weeks being seen once a week. During the initial intake, patient described that he was on his phone constantly due to work and his personal lifestyle. Patient estimated he was on his phone for approximately 3-4 hours a day. Initial onset of injury was estimated to be 2 months before his first visit.
On the first examination there was guarding and pain upon palpation of the wrist and forearm. On a scale of 10, the patient described his pain at a 7/8 level indicating a high pain level. With pain being more severe in the morning or after using his phone. There was also signs of heat on his forearm. There was a positive test for the Finkelstein maneuver. Using LI4, Lu 9 and LI 10 with moderate stimulation. We were able to decrease the pain by 40 percent within the first 2 days of treatment. The patient was told to come back once a week. Each subsequent visit resulted in less pain until the patient was healed.
What to expect
Most people suffering from De Quarvains can expect to see results within 2 treatments. With 90 percent of our clinic population demonstrating significant pain reduction by the end of 5 treatments.
