Wednesday, January 18, 2012

De Quervain syndrome - a frustration to any physiotherapist

De Quervain syndrome is severe tendon injury of the sheath or tunnel that surrounds two tendons that control movement of the thumb. Its nature is similar to another condition called "Carpal tunnel syndrome (CTS)" It is a painful and annoying condition, because in most activities using the hand, these thumb-tendons will be painfully activated.

The medical advice is, for lasting result, surgery. Non-surgical treatment, according to medical advice is:
  • Splints. Splints may be used to rest the thumb and wrist.
  • Anti-inflammatory medication (NSAIDs). These medications can be taken by mouth or injected into that tendon compartment. They may help reduce the swelling and relieve the pain.
  • Avoiding activities that cause pain and swelling. This may allow the symptoms to go away on their own.
  • Corticosteroids. Injection of corticosteroids into the tendon sheath may help avoiding swelling and pain.
The above non-surgical methods are more palliative in nature.  For a total non-surgical cure, your physiotherapist may suggest you to "mindfully exercise your thumb tendons" by simply extending and bending your thumbs in an aligned manner.  You will be told a "sluggish" feeling is an indication for doing it correctly.  And you will probably be asked to do a few sets per day with a certain number of repetitions per set.

However, what the physiotherapist doesn't tell you is that it won't work for the majority of his patients.  He is probably as frustrated as you!

Why? Because one needs to be trained in order that one can mindfully isolate and feel the stretching of one's (smaller) thumb tendons. And connecting into the right alignment, one must train one's tendon to be activated along a previously blocked path (that's why the requirement of feeling a "sluggishness' in one's exercise).

How to train one's tendon mindfulness? The most simple method is doing zhan zhuang.

De Quervan syndrome

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