A Closer Look at De Quervain’s Syndrome and Orthotic Management

Hinged long opponens orthosis for De Quervain tendovaginitis

The most common complaint in patients diagnosed with De Quervain’s Syndrome is radial sided wrist pain and tenderness, in the area of the first dorsal compartment of the extensor retinaculum. This compartment contains the Extensor Pollicis Brevis (EPB) and Abductor Pollicis Longus (APL) tendons. In this syndrome, hypertrophy of the retinaculum and thickening of the synovium has been noted.

Forceful, prolonged and/or repetitive thumb abduction and ulnar deviation – motions involved in many functional activities – may contribute to the syndrome. Pregnant women and mothers of young babies often are vulnerable.

The Finkelstein test (thumb held in palm and wrist strongly ulnarly deviated) typically elicits pain, localized to the radial styloid.

The Finkelstein Test typically elicits pain to the radial styloid.

Orthotic fabrication for De Quervain’s Syndrome

Conservative management of the De Quervain’s Syndrome typically includes activity modifications and orthotic wear. There appear to be more studies showing some degree of evidence to support the use and benefit of orthoses and/or immobilization to reduce symptoms.

A consensus study published by the European Hand Guide study in 2014 indicated that patient education, splinting/orthoses, NSAID’s and injections were all key components of the conservative management of this diagnosis.

Mardani-Kivi et al published a study (2014) looking at patients treated with a corticosteroid injection versus patients treated with a thumb spica cast (fibreglass) and a corticosteroid injection.

The combined treatment approach had a significantly higher success rate than injections alone, meaning that patients had no more pain at the radial wrist, less tenderness in the first dorsal compartment area and a negative Finkelstein test after 3 weeks of treatment. The thumb spica cast may seem a bit aggressive for those who prefer the use of orthoses, but the main goal was to immobilize the involved tendons and limit the use of wrist and hand.

Cavaleri et al published a systematic review (2016) looking at 6 studies comparing the effects of different treatment approaches for patients with de Quervain’s syndrome.

The authors compared hand therapy treatments (defined as therapeutic exercise, manual therapy, patient education, electrophysical agents, and also acupuncture and dry needling) combined with injections versus injections or hand therapy alone. The combined treatment approach appears to be more effective than any individual treatment on its own.

Long opponens vs. hinged long opponens

A study by Nemati and colleagues from Iran (2016) compared two different orthoses for management of symptoms in twenty-four women with acute De Quervain’s Syndrome: a long opponens orthosis versus a hinged version of the long opponens orthosis that permitted wrist extension and flexion, but blocked radial and ulnar deviation.

Regular long opponens orthosis (in Orficast More 12 cm)

Hinged long opponens orthosis (in Orfit Colors NS)

Although the testing period for this study was relatively short (2 weeks), all patients demonstrated decreased pain and increased strength and function. However, the group using the hinged orthosis demonstrated a significantly increased VAS (visual analogue scale) on a 100 point satisfaction scale for the treatment.

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