Carpal tunnel syndrome versus de Quervain’s tenosynovitis

Carpal tunnel syndrome versus de Quervain’s tenosynovitis

By Kristi McConnell, OTR/L, MOT, CHT, occupational therapist at South Sound Physical & Hand Therapy – Downtown Olympia

Carpal tunnel syndrome and de Quervain’s tenosynovitis are both common conditions of the wrist that can cause pain and discomfort. Both conditions can be identified and treated by an occupational therapist, who will develop an individualized treatment plan to get patients back to participating in the activities that they love while avoiding a recurrence or aggravation of the condition.

Carpal tunnel syndrome

Carpal tunnel syndrome is a condition in which the median nerve becomes compressed in the carpal tunnel of the wrist. It can be very painful and can cause numbness and tingling in the thumb, index finger, middle finger, and half of the ring finger. Individuals with this condition often report difficulty with performing tasks involving their hands, including buttoning shirts, zipping pants, and tying shoes.

Common causes of carpal tunnel syndrome include, but are not limited to, anatomy (some individuals have smaller carpal tunnels than others); injuries (e.g., wrist fracture); arthritis; diabetes; heavy use of vibratory tools (e.g., drills, lawn mowers, jackhammers); and pregnancy.

Conservative treatment for this condition can include nighttime splinting, nerve gliding exercises, activity modifications, taping methods, and manual therapy. Studies have shown that this condition is treated well with therapy in the earlier, milder stages. If left untreated, significant muscle loss can occur in the hand, resulting in an overall decrease in grip and pinch strength.

An occupational therapist or other qualified medical provider has diagnosed you with carpal tunnel syndrome. What can you do now?

• Wear a wrist brace at night to assure that your wrist is not bending forward while you sleep. Your occupational therapist can help you to select an appropriate brace or custom fabricate one for you.
• Take stretch breaks throughout the day, especially during prolonged desk work. The best position is the next position!
• Avoid heavy gripping and repetitive vibratory tasks.
• Prioritize general well-being: get in your fruits and vegetables, stay hydrated, check out a meditation application (e.g., Calm, Headspace), and exercise.

De Quervain’s tenosynovitis

De Quervain’s tenosynovitis is an inflammatory condition of the tendons of the wrist that can cause severe pain. This condition differs from carpal tunnel syndrome in that it occurs on the same side of the wrist as the thumb, and typically, there is no “pins and needles” sensation involved (unless there is sensory radial nerve involvement). The two affected tendons in de Quervain’s tenosynovitis are the abductor pollicis longus and the extensor pollicis brevis. These tendons are important as they assist with activities such as picking up a child and holding a coffee cup or cell phone.

Common causes of de Quervain’s tenosynovitis include, but are not limited to, repetitive activities and pregnancy. In pregnant individuals, inflammation of the tendons and/or thickening of the compartment within the wrist through which they run can occur. This often results in pain due to the tendons’ difficulty in gliding through the compartment. In this scenario, inflammation occurs secondary to hormonal changes that occur in individuals throughout pregnancy.

Conservative treatment for this condition may include splinting to maintain the thumb and wrist in a functional, yet protective position; activity modifications; manual therapy; taping techniques; and range-of-motion exercises to prevent stiffness while the tendons are allowed to rest. Once a period of protective immobilization is completed, an occupational therapist will assist you with conditioning exercises to help you to return to full participation in your daily activities.

An occupational therapist or other qualified medical provider has diagnosed you with carpal tunnel syndrome. What can you do now?

• Avoid repetitive activities that cause pain, and begin to modify activities as needed. For example, consider using the voice-to-text option on your phone, and switch hands often when holding your phone.
• Take rest breaks to reposition your arms, wrists and hands often.
• Again, take care of your whole, connected self. Eat your fruits and vegetables, stay hydrated, meditate, and move your body!

Kristi McConnell, OTR/L, MOT, CHT, is an occupational therapist at South Sound Physical & Hand Therapy – Downtown Olympia with specialized training in Astym therapy, hand therapy, orthotic fabrication, scar management and yoga instruction. Call South Sound Physical & Hand Therapy – Downtown Olympia to learn more at 360.754.7085, or click here to request an appointment with Kristi today.

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