Andere naam:
Peesschedeontsteking duim; Stenosing tenosynovitis of thumb
 

Korte omschrijving:
(Valt onder: overbelastingsblessures)
Irritation and swelling of the sheath or tunnel which surrounds the thumb tendons as they pass from the wrist to the thumb.
Irritation causes the compartment (lining) around the tendon to swell, changing the shape of the compartment; this makes it difficult for the tendons to move as they should.

Swelling about the tendons to the base of the thumb results in painful motion. (Afbeelding )


Oorzaak:

The cause of deQuervain's tendinitis is an irritation of the tendons at the base of the thumb.
Awkward hand positions is a common cause of this condition.
Routinely gripping an item - such as a musical instrument or power tool - for extended periods of time
Repetitive gripping actions: Musicians, writers, gardeners, construction workers and others whose work or hobbies require gripping.

You are also at greater risk if you have

  • Rheumatoid Arthritis
  • Diabetes
  • Are over 40 years of age

 




Diagnose:

LET OP: verwarring met intersection syndrome / roeierspols mogelijk!

  • No X-rays are needed to diagnose
  • Your doctor will examine your hand and fingers, and use the findings to make the diagnosis.
  • The finger may be swollen and there may be a bump, or nodule, over the joint in the palm of the hand.
  • The finger may be stiff and painful.
  • Although it may seem that the problem is in the knuckles, it is actually at the joint nearest the palm of the hand.

Finkelstein maneuver

  • In this test, the patient makes a fist with the fingers over the thumb.
  • The wrist is then bent in the direction of the little finger
  • This test can be quite painful for the person with deQuervain's tendinitis.
  • Tenderness directly over the tendons on the thumb-side of the wrist is the most common finding.
 
 
Behandelaars:
 
Behandelingen:
Gerelateerde blessures:
TenniselleboogVinger- en handproblemen - Algemene informatieDuim- en duimsteunproblemen
 
Symptomen:
Bewegingsbeperking bij strekken, Klikken, Knobbel, Opgezwollen, Pijn bij bewegen, Pijn bij spelen,
 
Instrumenten:
Althobo, Basklarinet, Dwarsfluit, Fagot, Hobo, Klarinet, Piccolo, Saxofoon, Drums, Pauken, Altviool, Cello, Contrabas, Viola da Gamba, Viool, Accordeon, Klavecimbel, Orgel, Piano, keyboard,
 

Anatomie:

The tendons are fibrous cords that connect the muscles of the forearm with the bones of the thumb and fingers.

  • Involves the tendons and pulleys in the hand that bend the finger. Normally, tendons in the thumb glide smoothly within their protective sheaths as you bend and straighten your finger-like cords through lubricated pipes.
  • DeQuervain's results from irritation, swelling, thickening and narrowing of the sheath that surrounds the tendon that bends (flexes) the affected thumb. This pinches and prevents the tendon from gliding smoothly, restricting tendon motion.
  • A bump (nodule) may also form.


Bezoek huisarts nodig?:

Most cases or flare-ups of DeQuervain's respond well to home treatment.
However, consult your doctor if:

  • Finger or thumb pain is disabling or doesn't subside after 10 days of home treatment
  • Excessive swelling, redness, bruising or a rash in the affected area
  • Pain is sharp or shooting, especially when you exercise or exert yourself
  • You have a fever
  • You have other medical conditions that may increase your risk of an infection, such as diabetes, rheumatoid arthritis or autoimmune diseases such as lupus
  • You take medications that increase your risk of infection, such as corticosteroids or immunosuppressants

Call your doctor immediately if you injured your thumb or finger and:

  • Your finger, thumb or wrist is very painful.
  • You cannot move your finger or thumb normally.
  • Your finger or thumb appears to be deformed.
  • Your finger or thumb begins to swell within 30 minutes of an injury.
  • You have signs of damage to the nerves or blood vessels of the fingers or hand, such as:
     
  • Numbness, tingling, or a "pins and needles" sensation below the injury. 
  • Pale or bluish skin. 
  • The limb feels colder to the touch than the uninjured limb.

 



Zelf doen:
>
  • Rust,
  • Physical therapy,
  • Occupational Therapy
  • Additional cortisone injections near the inflamed area of the bursitis.
  • Progress exercises to build flexibility, strength and restore wrist, finger/thumb function such as gripping an instrument.
  • <

    Chirurgische behandeling:

    More severe cases or those that do not respond to other treatment may require surgery.
    Modification of the activities which caused the symptoms initially also may be required.



    Niet-chirurgische behandeling:

    Acute inflammation usually passes if the activity which caused it is avoided long enough to give the finger or thumb sufficient rest.

    Later, a patient can gradually resume the activity incorporating gentle heat and prescribed stretching beforehand and icepacks afterward.
    More severe cases may require anti-inflammatory drugs or a cortisone injection and splinting.
    A physician may perform additional diagnostic tests to rule out other conditions before surgery is advised.
    Reduce inflammation!
    Relieve Pain & Protect/Rest,
    Treat with conservative therapy which involves:
    RICE  (Rest, Ice, Compression, and Elevation), NSAIDS, aspiration

    If an infection is likely?
    Antistaphylococcal antibiotics (e.g., amoxicillin/ clavulanate, nafcillin)
    May require admission for IV antibiotics the patient is toxic or there are comorbid conditions (e.g., immunosuppression, diabetes, etc?)
    Rest--
    Reduce/stop using the injured area for 48 hrs (Splinting).
    Ice--
    Put an ice pack on the injured area for 20 min. at a time, 4 to 8 times per day. (Use cold water with a plastic bag filled with crushed ice that has been wrapped in a towel or for a more localized strain ice massage may be in order. Get a paper or styrofoam cup, fill it with water and freeze. Tear the lip of the cup back and use the ice to massage your finger or thumb.).
    Compression--
    Usually is not used with trigger finger or thumb.
    Elevation--
    Keep the injured hand area elevated above the level of the heart. Use a pillow to help elevate the injury.
    Be sure to seek medical advice if the are signs or symptoms or infection or symptoms (pain and stiffness) persist more than 10-14 days--
    See a doctor or PT





    Algemene adviezen/preventie:

    The best way to prevent DeQuervain's Syndrome is to avoid repetitive gripping motion of of a finger (s) or thumb, especially if you are older (over age 40).
    Contraindication to Strengthening Exercise:

    • Do not do strengthening exercises if you have signs and symptoms of acute inflammation such as pain.
    • If you are already injured and in pain, such things may make it worse (indicates acute inflammation).

    What can you do right now when you have symptoms such as pain?

    • Risk Factor Reduction needs to take place to decrease modifiable, work related risk factors such as repetition, force, motions/technique, etc. (See return to playing schedule below)
    • In other words, change unhealthy practice habits!
       
    • Avoid long, continuous practice sessions without breaks nAvoid repertoire which calls for forceful squeezing of the fingers or repetitive passagework
    • Check that wrist remains straight while you play
    • Avoid twisting motions such as opening a door
     


    Encyclopedie:



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