De Quervain’s Tenosynovitis

I’m not going into the medical definition of the condition as thats not going to help any of you.
Here’s a link to have a quick look at what it is

Anyway, the usual methods to treat the problem is , in order of progression is….
1. Rest, icing/heat, bracing
2. Painkillers/ anti inflammatory drugs
3. Local injections (Steroid,local anaesthetic, prolotherapy or platelet rich plasma)
4. Surgical release of the tendon sheath/soft tissue that is causing movement restriction

I’d like to suggest a different approach based on holistic management of inflammation

  • A clean diet- Paleo/Keto or Vegetarian(gluten free and sugar free)
  • Sleep Hygiene
  • Movement of the affected thumb is gradual and mindful manner( instead of rest and bracing)
  • Occasional use of home remedies for inflammation

Now let me explain.
Inflamation is the basis for this disorder. A person whose body is in a pro inflamatory state will have more of an issue with DQTS, just like all chronic conditions.
Any diet that reduces the amount of inflammation in your system will help.

My recommendation is, in order of preference for

  1. Ketogenic
  2. Low carb Paleo
  3. Paleo
  4. Vegetarian (Gluten and sugar free)

Anti inflammatory home remedies like Turmeric and fish oil can also be used, but the main effect will come from the diet and sleep.

Movement is essential. Or rather, I should say, that proper movement is essential.
Identify which movement pattern is causing the tendon and it’s sheath to get inflamed. Those will need to be corrected.
Usual suspects are the use of an overly heavy hammer, a blunt knife that requires excessive force, Mobile phone use(whatsapp and chat- don’t you deny it!), computer mouse use
Now, these movements aren’t problematic by themselves, but when you do them in a manner that exceeds the healing capacity of your system, you are going to end up with trouble.

When DQTS starts, it starts with a mild pain or swelling at your wrist, the thumb side, or above. That is the initial inflammation that lets you know that you’ve been loading the tissue there excessively.

If you continue to do that, the pain and swelling builds. If you back off, the issue might go away, or it might get worse, depending on how good your body is at healing itself.

Let’s imagine that you eat a crappy diet, get hardly any sleep, and continue to load the inflamed tissue. The pain will continue to build till it starts restricting your movement. You’ll start to avoid moving the thumb to its full range of movement. The fluid that is filled with inflammatory mediators starts to stagnate in the areas around the tendon that don’t really move much. As days pass, the fluid there is reabsorbed slowly and the sticky proteins, that are left behind, get deposited around the tendon. They will act like mechanical blocks to free movement of the tendon. You might not notice it at first, because the loss of range is minimal.

As months go by, and the process repeats itself with episodes of pain, you continue to lose more and more of your range of movement, till one fine day, your thumb becomes effectively immobile.

Humans have opposable thumbs as one of their defining characteristics. Suddenly, you’ve become sub human. Even though it looks like it happened one fine day, the process has been going on for months and years. It just got to that point because, it happened while you weren’t paying attention. Now you need SURGERY!

That is not inevitable. Fix the problem as soon as it starts.

Clean up your diet. Recommendations are above.

Note- Conventional advice is to take complete rest till the pain goes away completely. I’m not a fan of that line of (in)action.

Once the stage of severe pain has passed, it is time to start moving gradually. The aim would be move up to the point of mild pain, and then go slightly beyond that point. If you have to grit your teeth and wrinkle your face in pain , you’ve gone too far.

Start to move the thumb and wrist gradually and smoothly in all possible directions under their own power, without forcing the joints using the other hand. Side to side, forward and backward, and rotatory movements in both directions. The movements need to be done for hundreds o f repetitions daily, with the numbers increasing as days go by. Ligaments and tendons have relatively poor blood supply, compared to bone and muscle. They rely on movement to get the necessary nutrients into themselves to effect satisfactory repair. That is what we aim to do by these hundreds of repetitions. You might start with movements upto a 20 or 30 on the first day, and if feeling better, increase the number on a daily basis by 20-30, as long as the pain keeps decreasing.

  • If the exercises make your wrist hurt more the *next* day, you’ll need to drop the number of repetitions or hold them steady.
  • If the pain gets worse on consecutive days, give your wrist a day off and try again.
  • You should see consistent improvement after 5 days
  • And it should settle well with the diet and movement practice by 2-3 weeks.

The other benefit of constant movement is that it prevents the inflammatory fluid from sticking to tissues that are meant to glide freely across each other. Every time they start forming up adhesions, the movement disrupts them or at least stretches them out and prevents range of movement loss

This might give you a fighting chance to avoid surgery.

Disclaimer– If you are unsure of the problem you’re having, or if it isn’t improving as expected, you should see a healthcare professional who can examine and guide you. What is described above is an attempt at avoiding injections and surgery.

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