Physiotherapy plays a crucial role in the management of De Quervain’s tenosynovitis, especially after a fracture. The goals are to reduce pain and inflammation, restore tendon gliding, improve range of motion, and strengthen the affected muscles.

Manual Therapy

• Joint Mobilizations: Gently mobilizing the carpal bones and wrist joint can help improve overall wrist mechanics and reduce stiffness that may contribute to tendon irritation.
• Soft Tissue Massage: Direct massage to the forearm muscles (Abductor Pollicis Longus and Extensor Pollicis Brevis) and the tendon sheath can help reduce tension, improve blood flow, and break down adhesions. Cross-fiber massage is particularly effective for the distal tendons and their synovial sheath.
• Fascial Spreading Strokes: Applied to the forearm, hand, and thumb to address fascial restrictions.

Myofascial Release (MFR)

MFR focuses on releasing restrictions in the fascia, the connective tissue that surrounds muscles. By applying sustained pressure and stretching, MFR can improve tissue mobility, reduce pain, and restore proper function. For De Quervain’s, MFR would target the forearm flexors and extensors, as well as the retinaculum around the wrist.

Instrument-Assisted Soft Tissue Mobilization (IASTM)

IASTM utilizes specialized tools (e.g., Graston instruments) to detect and treat soft tissue restrictions, scar tissue, and fascial adhesions. The instruments can help break down collagen cross-links, promote cellular regeneration, and increase blood flow to the affected area, aiding in the healing process of the inflamed tendons and their sheaths.

Active Release Technique (ART)

ART is a patented, hands-on soft tissue system that diagnoses and treats soft tissue injuries. It involves applying specific pressure to the affected muscle, tendon, or ligament while the patient actively moves the body part through a specific range of motion. For De Quervain’s, ART would target the APL and EPB, releasing adhesions and restoring normal gliding of the tendons.

Muscle Energy Technique (MET)

MET uses the patient’s own muscle contractions to relax and lengthen tight muscles and improve joint motion. For De Quervain’s, MET could be used to gently stretch the involved muscles (APL and EPB) and improve the mobility of the thumb and wrist joints. This typically involves an isometric contraction of the muscle followed by a passive stretch.

Dry Needling

Dry needling involves inserting thin needles into trigger points or tight bands of muscle to release tension, reduce pain, and improve blood flow. For De Quervain’s, dry needling can target trigger points in the APL and EPB muscles, as well as surrounding forearm muscles that may be contributing to the problem. It can help reduce local inflammation and release muscle fibers.

Kinesiology Taping

Kinesiology tape is an elastic therapeutic tape that can be applied to support muscles and joints, reduce swelling, and alleviate pain. For De Quervain’s, taping techniques can be used to:

• Support the thumb and wrist: Providing gentle support to the APL and EPB tendons without restricting full range of motion.
• Reduce swelling: By lifting the skin, it can create more space for lymphatic drainage.
• Facilitate muscle function: By applying tape in a way that assists muscle contraction or relaxation.