De Quervain's Tenosynovitis

[Alex Middleton]

AKA tendonitis behind the thumb.  In my case, the right thumb.  Between this, and the A-fib spell I had over the weekend that prompted a trip to the ER, I think I might actually be getting old.

[billyO]

15 hours ago, Alex Middleton said:

Between this, and the A-fib spell..

 

Sorry to hear about that, Alex.   Welcome to your 4th decade!  Try to remember how you're feeling today when you hit the 5th (as I just did a month ago..I'm probably pointing out the obvious here that it doesn't get easier.) 

 

Hopefully the A-fib was a one off and easy to fix/prevent in the future.

 

Are you doing any stretching of the thumb extensors/abductors (ie the finkelstein stretch)?  Icing? 

If this isn't a one-off and a recurring problem, I'd suggest seeing a PT or OT (find a CHT if you can) as soon as our movements are not longer restricted.

Feel free to contact me either here or in PM if you have any questions.

Edited April 9, 2020 by billyO
speling

[Alex Middleton]

Thanks for the advise Billy.  My doc had me do the finkelstein stretch in the office as part of the diagnosis.  A little heads up on how much that was going to hurt would have been nice!  The icing and stretching routine starts tonight, along with ibuprofen or Aleve until it starts feeling better.  Doc said to call back in a few weeks or so if theres no progress and we'd talk about other options.

I've had spells of A-fib here and there for the last 12-13 years.  This was the first time it lasted overnight and in to the next day.  Now I get to wear a monitor for a month and go from there.

If this is 40, I feel sorry for you really old farts.  Life must be hell!

[Alan Longmire]

I was complaining about what turned out to be de Quervain to my rheumatologist last year, thinking that the psoriatic arthritis had spread.  She just laughed and said "Nope, that's a whole 'nother problem."  The stretches do help as long as you don't overdo it.  It seems there are certain things we do in knifemaking that aggravate that stupid tendon, with filing, hand sanding and guard fitting being major culprits.  It forces you to pay attention to technique, though... 

 

 

[Brian Dougherty]

Hmm, let me guess, grasping little needle files with no handles, and applying awkward pressure on pieces of abrasive paper with thumb and fingertips until your knuckles lock up being some of the culprits? 

 

I checked out this stretch you guys mentioned.  Either I'm doing it wrong, or it doesn't challenge me yet.  (Guess which one it likely is...)  I'll have to look into this a bit more to see if it is a preventative measure.

[Alan Longmire]

Do the Finkelstein test (not the therapy stretch!) and get back to us... 

 

If you don't want to look it up, sit comfortably and hold your hand out like a handshake, thumb pointing straight up, elbow at 90 degrees. Fold your thumb down into your palm and make a fist, then tilt your wrist straight down towards the floor. If you have this particular variety of tendonitis, someone will need to peel you off the ceiling.

[billyO]

28 minutes ago, Brian Dougherty said:

Either I'm doing it wrong, or it doesn't challenge me yet. 

No need to push this and look for pain.  It is both a test and treatment.  If there's no pain or decreased range of motion when you do the test/stretch, you don't have a problem (well..at least not a tenosynovitis anyway....) and don't have to worry about it.  This stretch is only appropriate/necessary if there's a significantly painful tightness or decrease in range of motion in the thumb extensors/abductors.

 

Edited April 9, 2020 by billyO

[Emiliano Carrillo]

I dealt with this when I was maybe 12-13 after I had made my first two chainmail shirts. Same culprit as with bladesmithing, repetitive motion with significant resistance is a great way to damage that little sleeve that holds the tendon. I used to try and push thought it a bit to finish projects that needed finishing, but learned the hard way that it is the worst way to deal with it. What I've done in the past is the stretch that Alan mentioned, which I still do sometimes, and just not doing any hand work for two weeks. Not ideal, especially when you want to work but it is the only way to make yourself feel better. That and flector patches helped. 

[Alex Middleton]

22 minutes ago, Alan Longmire said:

If you have this particular variety of tendonitis, someone will need to peel you off the ceiling.

You're not kidding there Alan.  I had no issues when I tucked my thumb in so I figured the Doc was wrong.  Rocked my wrist down way too far and too fast because I wanted to get on to the next test, and I damn near fell out of the chair.

 

After hearing you guys, I'm beginning to think that the fit and finish for the dagger I'm working on is what caused this to flair up.  Lots of needle files with no handles.  Almost done though........

[Guy Thomas]

I figured I'd find something here on this. I seem to be having issues with my left hand thumb/wrist that appears to be most certainly this De Quervain's Tenosynovitis though I haven't been to the doctor with it... yet. Appears to be relatively mild at this point, the Finkelstein test doesn't cause excruciating pain, just discomfort.

 

Some of the exercises/stretches for it seem to be helping and I'm going to start using ice this evening. I'm thinking it won't get better however unless I simply don't use that hand much for a time? With a brace maybe? So does it go away completely or is this something you can count on re-occurring? 

[Alan Longmire]

It's like any form of tendonitis.  Ice and ibuprofen/naproxen to stop the inflammation, rest to let it heal.  Compression if you can, but that's a difficult spot to keep compressing. You can strap your thumb down with an Ace bandage, but that limits your ability to use your hand.

 

Also like any form of tendonitis, it will come back if you do whatever it was you were doing to cause it in the first place.  I'm having a minor flare-up of it right now, in fact.  Some of the motions required to do that tomahawk I'm working on are not kind to that tendon.  It's not to the stage that the Finkelstein test is excruciating, but then I'm only doing the work on weekends, so it has time to heal a bit in between sessions.  

[Guy Thomas]

Thanks Alan, about what I thought. Of course this happens right when I am trying to wean myself off as much as possible the daily Indocin for my ankylosing spondylitis that I have been taking for far too many years. Took my dose last night and the thumb is much better today, lol

[Alan Longmire]

1 hour ago, Guy Thomas said:

ankylosing spondylitis

 

Didn't realize you're a member of the rheumatological autoimmune fan club as well!  Sorry to hear it, though, that's a particularly evil one to have. 

[Guy Thomas]

25 minutes ago, Alan Longmire said:

 

Didn't realize you're a member of the rheumatological autoimmune fan club as well!  Sorry to hear it, though, that's a particularly evil one to have. 

Yes, as a club it leaves much to be desired doesn't it. I've been relatively fortunate though, the disease has gradually worked it's way from my coccyx up to my neck/shoulder area where it currently resides and I've remained relatively flexible and active. It may in time "burn" itself out which may be why I'm now able to go for days without medication if I try (I'm beginning to fear the side effects of taking the medication for extreme long term use more than the disease). It's not NEARLY as bad as it was when I was much younger and it affected the sacroiliac joints too or later where my ribs connect. In my late twenties through mid-forties I had what I called the "ruptured-duck" walk, lol. Damn I ramble too much these days!