Case presentation on dequervain's tenosynovitis.

1. “An orthotic case
presentation on thumb
spica for treatment of
De Quervain’s
Tenosynovitis”
Presented by-Amisha
Bharti
Bpo final year

2. • De Quervain's Tenosynovitis is a painful,
inflammatory condition caused by tendons on the
side of the wrist at the base of the thumb.
• It mainly affects the abductor pollicis longus(APL)
and the extensor pollicis brevis(EPB) tendon and 1st
dorsal compartment of the wrist.
• It is characterized by degeneration and fibrosis of the
tendon sheath.
Introduction
Extensor pollicis
brevis
inflamed and swollen
tendon sheaths
Abductor
pollicis longus

3. • The most common cause of de Quervain’s tenosynovitis is due to overuse or
repetitive stress of the wrist and hand, causing inflammation of the
tendons.
• Direct injury to the wrist or tendon,which may cause scar tissue that
restricts movement of the tendons.
• People between the ages of 30-50 have a higher risk of developing this
disease.
• More common in women and in dominant hand.
Etiology

4. 01
ASSESMENT
Demographic Data-

5. Patient medical history
Past medical history- Since 1 month she is having pain over the dorso-
radial side of the wrist and the radial aspect of the
forearm.
Present medical condition-
Orthotic history-
At present she is taking medicine for pain relief
and swelling.
She didn’t use any orthosis till the day of assessment.

6. Therapeutic history-
Personal history-
Occupation-
Family member-She is living with her husband and son.
Economical condition-Financial condition is average.
Socio-geographical condition-They live in urban area.
Orthotic intervention -Patient is prescribed with Rt.thumb spica
For tendon sliding and grip strengthening
exercises she come to physiotherapy department of
NILD.
She is a home-maker.

7. .
On observation
• The primary complaint of patient is pain on radial side of wrist.(base of thumb
and dorsolateral aspect of the wrist near the radial styloid process) the pain
radiates up to the forearm with grasping or extension of the thumb.
• By Palpation tenderness is found over the radial styloid and the first dorsal
compartment. Pain often radiates distally to the thumb or proximally up the
distal forearm, especially with radial or ulnar deviation of the wrist.

8. on observation
Onset of pain:1 months
Frequency: Constant
Location of pain:Around radial styloid of right hand
pain intensity(VAS Scale): not checked
Aggravating factor: Squeezing clothes, Cooking meals
Relieving factor:
Quality of pain: burning pain
Tenderness over first dorsal compartment:present
Morning stiffness: present
Swelling: absent
Redness of the skin: absent
Pain
Soft tissue massage and
resting

9. Radiological investigation
No bone abnormality is noted

10. Range of motion

11. Clinical examination
Finkelstein’s
test:
• The Finkelstein test is commonly only used
to diagnose de Quervain diseases.
• The patient is asked to fully flex and
adduct the thumb with the wrist in ulnar
deviation,she may experience sharp pain
in the first dorsal compartment because
the tendons are simultaneously stretched
and compressed over the radius in an
already inflamed condition.

12. • The finkelstein’s test is found positive.
• Due to the presence of pain at the dorsal
side of hand of patient.

13. Rehabilitation Goal
• To prevent repetitive movement of right thumb .
• To reduce pain by immobilizing the thumb at a desired position .
• To reduce forceful exertion of the abductor pollicis longus (APL) and the
extensor pollicis brevis (EPB )muscles.
• To improve overall hand function.

14. Biomechanical control
Supportive
force
Supportive
force
Corrective
force
• Most splints used in upper
extremity clinical practice apply
consistent, linear-oriented, three-
point pressure systems to act joint
motion. These splints incorporate
three parallel reciprocal forces
with the proximal and distal forces
oriented in the same direction and
the middle reciprocal force
oriented in the opposit.

15. ASHT orthotic splint nomenclature
Articular
Location:-wrist joint
Direction:-Motion restriction/immoblization
Thumb MCP extension immobilization type 2(3)

16. Fabrication procedure
• Before making pattern take all the necessary measurement.Also
take the tracing of hand.
• According to the measurement make the pattern on tracing
paper.
• Place this pattern on aluminium sheet and stick properly.
• After that cut the extra part by using hand metal cutter or
shearing machine.
• By using metal file smooth the sharp edges.
• From proximal to distal bend the metal piece according to the
patient anatomical position of hand.
• Place the press button on proximal and distal part to fasten the
velcro loop and hoop part.
• Lastly,with the 2 mm evathin cover both side of the splint.

17. Fabrication procedure
Thumb spica splint
pattern
Cutting of extra part by using shearing
machine

18. By using hammer and
cold chisel cut extra
part.
Pattern of thump spica
splint
With the help of metal file
smoothen the edges

19. Strapping and
padding

20. Patient without
orthosis
Palmar
view
Lateral view Dorsal view

21. Dorsal
view
Palmar
view
Lateral
view
Patient with orthosis (Thumb
spica)

22. Patient wearing thumb spica

23. Wearing schedule
• A thumb spica splint is designed to be used during the day when support
is needed and when patient do daily activities .
• It immobilises the painful joints of the thumb and gives wrist support.
• Don't wear the splint for longer than two hours at a time, as this may
weaken the hand muscles.

24. clinical checkout
The splint has been fitted appropriately to adapt the following:
1) Anatomical structure (bony prominences, skin creases)
2) Ligamentous stress (immobilization, mobilization, restriction, or torque
transmission forces correctly applied to avoid damage.
3) Joint alignment (anatomical axes aligned with splint articulation; splint
does not shift inappropriately on extremity).

25. clinical checkout
4) Kinematic changes (splint does not inappropriately inhibit motion of
unrestricted or partially restricted joint.
5) Good overall esthetic appearance. Corners rouinded, edges and surfaces
smooth and anged appropriately.
6) Ventilation (appropriately placed, splint strength not jeopardized).

26. THANK YOU!