DQT MEDBACK

This muscle starts from the back of the forearm bones and attaches to the base of the first thumb bone (the first metacarpal). Its job is to pull the thumb away from the hand (thumb abduction). .

Abductor Pollicis Longus (APL):

This smaller muscle starts lower down on the radius and attaches to the base of the first thumb joint (proximal phalanx). It helps straighten the thumb at its middle joint

Extensor Pollicis Brevis (EPB):

Tendons:

The tendons of the APL and EPB muscles are long cords that travel down the wrist and into the thumb. These tendons pass through a narrow tunnel on the side of the wrist called the _____. Inside this tunnel, the tendons are held in place called a _____, which helps them slide smoothly. In De Quervain’s tenosynovitis, the tendons or their sheaths get swollen or irritated from overuse, especially from motions like lifting, texting, or twisting the wrist. This swelling makes it harder for the tendons to move and causes pain when using the thumb or wrist (VanPutte et al., 2017).

Tendons:

The tendons of the APL and EPB muscles are long cords that travel down the wrist and into the thumb. These tendons pass through a narrow tunnel on the side of the wrist called the first dorsal compartment. Inside this tunnel, the tendons are held in place called a synovial sheath, which helps them slide smoothly. In De Quervain’s tenosynovitis, the tendons or their sheaths get swollen or irritated from overuse, especially from motions like lifting, texting, or twisting the wrist. This swelling makes it harder for the tendons to move and causes pain when using the thumb or wrist (VanPutte et al., 2017).

Ligaments:

A thick band of tissue called the _____ holds the tendons close to the wrist so they don’t pop out of place when the hand moves. It forms the top of the tunnel where the APL and EPB tendons pass. If this area gets too tight or swollen, the tendons get trapped, making it painful to move the thumb. In some people, a wall inside the tunnel separates the two tendons, and that can make the condition worse (VanPutte et al., 2017).

Ligaments:

A thick band of tissue called the extensor retinaculum holds the tendons close to the wrist so they don’t pop out of place when the hand moves. It forms the top of the tunnel where the APL and EPB tendons pass. If this area gets too tight or swollen, the tendons get trapped, making it painful to move the thumb. In some people, a wall inside the tunnel separates the two tendons, and that can make the condition worse (VanPutte et al., 2017).

PATHOPHYSIOLOGY

De Quervain’s Tenosynovitis starts when the sheath around the APL and EPB tendons gets inflamed. This usually happens because of doing repeated movements like thumb abduction or wrist ulnar deviation, which triggers an inflammatory reaction within the sheath. The fluid inside the sheath increases thus, leads to irritation and swelling.

__________, which is characterized by disordered collagen fibers, thickening of the sheath, and the buildup of fibrous materials like collagen, may develop in chronic situations if repetitive stress persists over time (Magee et al., 2016; Dutton, 2020 ; Frontera et al., 2010 ; Skirven et al., 2011).

PATHOPHYSIOLOGY

De Quervain’s Tenosynovitis starts when the sheath around the APL and EPB tendons gets inflamed. This usually happens because of doing repeated movements like thumb abduction or wrist ulnar deviation, which triggers an inflammatory reaction within the sheath. The fluid inside the sheath increases thus, leads to irritation and swelling. Myxoid (mucoid) degeneration, which is characterized by disordered collagen fibers, thickening of the sheath, and the buildup of fibrous materials like collagen, may develop in chronic situations if repetitive stress persists over time (Magee et al., 2016; Dutton, 2020 ; Frontera et al., 2010 ; Skirven et al., 2011).

DIAGNOSTIC CONSIDERATIONS

This is primarily used to diagnose wrist tenosynovitis;

Finkelstein’s test

DIAGNOSTIC CONSIDERATIONS

This is used to eliminate other causes of pain.

X-ray of the wrist

DIAGNOSTIC CONSIDERATIONS

This is used for assessing the presence of hypoechoic fluid in the tendon sheath and the severity and signs of inflammation in a tenosynovitis.

Ultrasound

DIAGNOSTIC CONSIDERATIONS

This can reveal the inflamed site, thickening of the retinaculum, tendon sheath, and tendons.

Magnetic Resonance Imaging (MRI)

DIAGNOSTIC CONSIDERATIONS

If a patient chooses corticosteroid injection as a treatment, it is important to identify a _____ dividing the first compartment, as it may cause the treatment to fail (Frontera & Silver, 2018).

DIAGNOSTIC CONSIDERATIONS

If a patient chooses corticosteroid injection as a treatment, it is important to identify a septum dividing the first compartment, as it may cause the treatment to fail (Frontera & Silver, 2018).

DIFFERENTIAL DIAGNOSIS

Moreover, neurological considerations involve “Wartenberg syndrome (what nerve is entrapped in this condition?)

Superficial radial nerve

MEDICAL MANAGEMENT

In case of immediate treatment, the most common path is _____ is administered in each tendon sheath of the extensor pollicis brevis and abductor pollicis longus, located 1 cm higher the radial styloid process at 30-45 degree angle from its epidermis and should be aligned with the area of the tendon (Cifu, 2016 ; Magee et al., 2016). Also, the needle should stick proximally or distally, not directly on the place of the tendon. These are the meticulous considerations that should be noted to avoid injuring the nearby nerves such as superficial radial nerves (Cifu, 2016). Most of the time, 80% of the patients who received two corticosteroids injections can alleviate the symptoms (Magee et al., 2016). Nonetheless, side effects of corticosteroid injections can result in subcutaneous atrophy, lack of pigmentation, and fat necrosis (Magee et al., 2016).

MEDICAL MANAGEMENT

In case of immediate treatment, the most common path is corticosteroid injection is administered in each tendon sheath of the extensor pollicis brevis and abductor pollicis longus, located 1 cm higher the radial styloid process at 30-45 degree angle from its epidermis and should be aligned with the area of the tendon (Cifu, 2016 ; Magee et al., 2016). Also, the needle should stick proximally or distally, not directly on the place of the tendon. These are the meticulous considerations that should be noted to avoid injuring the nearby nerves such as superficial radial nerves (Cifu, 2016). Most of the time, 80% of the patients who received two corticosteroids injections can alleviate the symptoms (Magee et al., 2016). Nonetheless, side effects of corticosteroid injections can result in subcutaneous atrophy, lack of pigmentation, and fat necrosis (Magee et al., 2016).

MEDICAL MANAGEMENT

Recent management has also adapted for De Quervain’s tenosynovitis such as _______. This rising technique carries growth factors that serve as regenerative catalyst for healing of the damaged tendon sheaths. The existence of PRP injection on the area creates gathering of the molecules, which can result in accelerated functional recovery (Alam et al., 2024)

MEDICAL MANAGEMENT

Recent management has also adapted for De Quervain’s tenosynovitis such as platelet-rich plasma (PRP) injections. This rising technique carries growth factors that serve as regenerative catalyst for healing of the damaged tendon sheaths. The existence of PRP injection on the area creates gathering of the molecules, which can result in accelerated functional recovery (Alam et al., 2024)

MEDICAL MANAGEMENT

Other alternative injections have also been reported for the treatment of De Quervain’s. ______ has shown significant improvement in terms of reduction of discomfort and regaining normal function than _____ (Al-Mohrej et al., 2022). Nevertheless, corticosteroids injection is the most commonly used among them.

MEDICAL MANAGEMENT

Other alternative injections have also been reported for the treatment of De Quervain’s. Ketorolac injection has shown significant improvement in terms of reduction of discomfort and regaining normal function than Triamcinolone acetonide (Al-Mohrej et al., 2022). Nevertheless, corticosteroids injection is the most commonly used among them.

MEDICAL MANAGEMENT

During comparison study from Haralson & Kaye (2024), it was reported that _____________ give identical results of pain relief, improvement of UE’s function and patient satisfaction. However, ____________ shows more superficial side effects. The use of ultrasound or palpation still depends on clinician’s experience and patient’s preference.

MEDICAL MANAGEMENT

During comparison study from Haralson & Kaye (2024), it was reported that both assistance from ultrasound & palpation-guided give identical results of pain relief, improvement of UE’s function and patient satisfaction. However, palpation-guided administration of injection shows more superficial side effects. The use of ultrasound or palpation still depends on clinician’s experience and patient’s preference.

SURGICAL MANAGEMENT

Generally, physical therapy and pharmacological interventions can manage the symptoms of De Quervain’s Tenosynovitis. However, surgery is the last line of treatment when conservative management becomes inadequate. The approach will begin with the ___________, and may be followed by tenosynovectomy. It is highly regarded that accurate visual perception of the first dorsal compartment is a crucial step, as it is needed to remove any septa that hinder the wrist and ensure that each tendon can move without any signs of constraint before ending the surgery. Risk factors of this management include impairment of nerves that lie on the radial aspect, such as the painful neuroma of the superficial sensory branch of the radial nerve or the lateral antebrachial cutaneous nerve. Unable to remove the subsheaths or the septum between the sheaths may result in further pain and declined motion (Magee et al., 2016). Up to this date, this is the type of surgery that is frequently performed on De Quervain's tenosynovitis

SURGICAL MANAGEMENT

Generally, physical therapy and pharmacological interventions can manage the symptoms of De Quervain’s Tenosynovitis. However, surgery is the last line of treatment when conservative management becomes inadequate. The approach will begin with the incision of extensor retinaculum, and may be followed by tenosynovectomy. It is highly regarded that accurate visual perception of the first dorsal compartment is a crucial step, as it is needed to remove any septa that hinder the wrist and ensure that each tendon can move without any signs of constraint before ending the surgery. Risk factors of this management include impairment of nerves that lie on the radial aspect, such as the painful neuroma of the superficial sensory branch of the radial nerve or the lateral antebrachial cutaneous nerve. Unable to remove the subsheaths or the septum between the sheaths may result in further pain and declined motion (Magee et al., 2016). Up to this date, this is the type of surgery that is frequently performed on De Quervain's tenosynovitis

PHYSICAL THERAPY REHABILITATION CONSIDERATION/GUIDELINES

Physical therapy rehab for De Quervain focuses on reducing pain, inflammation, and restoring function. During the early stages of treatment, a ________, is recommended to minimize movements of the wrist and thumb while allowing the tip of thumb to move. This can be used 4-6 weeks in order to reduce stress on the irritated tendons. Patient education is taught regarding proper hand positioning and activity modification to avoid further irritation during ADLs (Magee, Zachazewski, & Quillen, 2015). The position of the hand with the assistive device is _____° wrist extension, no signs of radial or ulnar deviation, _____° thumb MCP flexion. In spite of that, the interphalangeal joint (IP) should not be limited and should be able to touch with index and long finger to ensure hand function (Cifu, 2016). This offers short-term relief, yet this only lasts while wearing the cast or splint (Magee et al., 2016)). After 3-6 weeks post management, ROM exercises with incremental increase of strength training should be performed to be able to regain movement (Dutton, 2020). Nonetheless, the efficacy of this medical path alone in treating De Quervain’s Tenosynovitis is 30% (Magee et al., 2016).

PHYSICAL THERAPY REHABILITATION CONSIDERATION/GUIDELINES

Physical therapy rehab for De Quervain focuses on reducing pain, inflammation, and restoring function. During the early stages of treatment, a thumb spica splint, forearm based, is recommended to minimize movements of the wrist and thumb while allowing the tip of thumb to move. This can be used 4-6 weeks in order to reduce stress on the irritated tendons. Patient education is taught regarding proper hand positioning and activity modification to avoid further irritation during ADLs (Magee, Zachazewski, & Quillen, 2015). The position of the hand with the assistive device is 15° wrist extension, no signs of radial or ulnar deviation, 10° thumb MCP flexion. In spite of that, the interphalangeal joint (IP) should not be limited and should be able to touch with index and long finger to ensure hand function (Cifu, 2016). This offers short-term relief, yet this only lasts while wearing the cast or splint (Magee et al., 2016)). After 3-6 weeks post management, ROM exercises with incremental increase of strength training should be performed to be able to regain movement (Dutton, 2020). Nonetheless, the efficacy of this medical path alone in treating De Quervain’s Tenosynovitis is 30% (Magee et al., 2016).

PHYSICAL THERAPY REHABILITATION CONSIDERATION/GUIDELINES
Based on the systematic review of physical modalities of wrist & hand tenosynovitis (Ferrara et al., 2020), the common physical agents employed in physical therapy for DQT are __________________.

____________ uses high-frequency sound waves, specifically 3mHz for DQT, for pain reduction and accelerate healing process. ____________ provides minimizing the discomfort, but no changes on the level of inflammation nor grip strength. Yet, it is recommended that combination of strength and stretching exercises with ultrasound or low level therapy increases its probability of rehabilitation before proceeding to a more aggressive form of treatment like surgery. ____________ suggests that it is not better in terms of pain relief or improved hand mobility to any conservative management such as splints or exercise (de la Barra et al., 2025). More extensive research of modalities needs to be looked at such as _______________. This type of management together with the application of splints in the recovery period have indicates pain control, refined UE movement and improved hand grip. This still needs to be studied d/t its minimal researches (Haghighat, Vahdatpur, & Ataei, 2021)

PHYSICAL THERAPY REHABILITATION CONSIDERATION/GUIDELINES
Based on the systematic review of physical modalities of wrist & hand tenosynovitis (Ferrara et al., 2020), the common physical agents employed in physical therapy for DQT are ultrasound and laser therapy.

Therapeutic ultrasound uses high-frequency sound waves, specifically 3mHz for DQT, for pain reduction and accelerate healing process. Low level laser therapy provides minimizing the discomfort, but no changes on the level of inflammation nor grip strength. Yet, it is recommended that combination of strength and stretching exercises with ultrasound or low level therapy increases its probability of rehabilitation before proceeding to a more aggressive form of treatment like surgery. High level laser therapy suggests that it is not better in terms of pain relief or improved hand mobility to any conservative management such as splints or exercise (de la Barra et al., 2025). More extensive research of modalities needs to be looked at such as extracorporeal shockwave therapy. This type of management together with the application of splints in the recovery period have indicates pain control, refined UE movement and improved hand grip. This still needs to be studied d/t its minimal researches (Haghighat, Vahdatpur, & Ataei, 2021)

PHYSICAL THERAPY REHABILITATION CONSIDERATION/GUIDELINES
Based on the systematic review of physical modalities of wrist & hand tenosynovitis (Ferrara et al., 2020), the common physical agents employed in physical therapy for DQT are __________________.

ultrasound and laser therapy.

PHYSICAL THERAPY REHABILITATION CONSIDERATION/GUIDELINES

____________ uses high-frequency sound waves, specifically 3mHz for DQT, for pain reduction and accelerate healing process.

Therapeutic ultrasound

PHYSICAL THERAPY REHABILITATION CONSIDERATION/GUIDELINES

____________ provides minimizing the discomfort, but no changes on the level of inflammation nor grip strength. Yet, it is recommended that combination of strength and stretching exercises with ultrasound or low level therapy increases its probability of rehabilitation before proceeding to a more aggressive form of treatment like surgery.

Low level laser therapy

PHYSICAL THERAPY REHABILITATION CONSIDERATION/GUIDELINES

____________ suggests that it is not better in terms of pain relief or improved hand mobility to any conservative management such as splints or exercise (de la Barra et al., 2025). More extensive research of modalities needs to be looked at such as

High level laser therapy

PHYSICAL THERAPY REHABILITATION CONSIDERATION/GUIDELINES

_______________. This type of management together with the application of splints in the recovery period have indicates pain control, refined UE movement and improved hand grip. This still needs to be studied d/t its minimal researches (Haghighat, Vahdatpur, & Ataei, 2021)

extracorporeal shockwave therapy