Introduction
De Quervain’s tenosynovitis is a very painful condition that affects mostly ladies of the age 30 to 50. This causes debility of the hands mostly thumps that restricts the movements of them. It is more evident in people who works the most time in their computer. Movements that needs the movement of wrists like doing dishes, writing, drying of clothes etc are also tend to be affected due to this disease.
Signs and symptoms of De Quervain’s tenosynovitis
Pain in the wrist and the area near the base of the thump
Difficult movements or restricted movements of the wrist and fingers, especially thump
S feeling of stick inside in the thump or pain on and off in the area
Oedema of the hand, more in the wrist area
Causes of De Quervain’s tenosynovitis
Exact cause is still not clear. Butr many risk factors are identified, like lifting weight with bare hands, repetitive movements or actions that include wrist and thump, chronic diseases like diabetes or rheumatoid arthritis etc. Pregnancy can also be seen as a triggering factor in some cases.
Pathophysiology of De Quervain’s tenosynovitis
Tendons of abductor pollicis longus and extensor pollicis brevis develops in De Quervain’s tenosynovitis at the level of the radial styloid process.
Diagnosis of De Quervain’s tenosynovitis
Physical examination including Finkelstein test, in which thumb is bent across the palm followed by bending of other fingers over the thumb. After that, the wrist is bent towards the little finger and if this causes pain in the wrist near the thumb, then this test is considered positive and the diagnosis is taken as De Quervain’s tenosynovitis
Usually, imaging tests like X rays are not used to diagnose this condition
Treatments for De Quervain’s tenosynovitis
- First and foremost, the method is to immobilise the area. It is important to keep the thumb and wrist straight with a splint or a brace to give rest to the ligaments and tendons.
- Avoid movements of the area as effectively as possible.
- Moving of the thumb and wrist should be avoided especially sideways.
- In more serious cases, surgery is needed to release the pressure and remove inflammatory residue.
Prognosis of De Quervain’s tenosynovitis
Most cases of De Quervain’s tenosynovitis show good results when immobilised properly. It is always good to start the treatment early to get better results. Surgery may not be needed if immobilised in the early stages, but even cases after surgery show high success rates.
Complications of De Quervain’s tenosynovitis
Though the condition seems not much serious, untreated cases of De Quervain’s tenosynovitis may lead to serious complications like oedema, bruises, excessive bleeding and collection of blood under the skin or any wound(haematoma). Such conditions may cause serious infection or dehiscence of the wound (cutting open the wound edges due to defective healing).
De Quervain’s tenosynovitis and Ayurveda
Sandhigatavaata
Nidana-Ayurvedic causes
Dhaatukshaya(degeneration)
Aavarana(obstruction to channels in the body)
Poorvarupa- Ayurvedic premonitory signs and symptoms
Not mentioned
Samprapti-Ayurvedic pathogenesis
Due to the causative factors Vaata gets vitiated and gets lodged in the joints causing pain and swelling.
Lakshana – Ayurvedic signs and symptoms
Vaatapoornadrutisparsam – Feel of an air-filled bag on touch
Sopham – Swelling
Prasaaranaakunchanayo: savedanaam pravrthim- Painful movements of joints like flexion and extension
Sadhyasadhyata-Ayurvedic prognosis
Yaapya (manageable with medicines, therapies and Pathya)
It is saadhya/krichrasadhya if it is new and involves only singe joint.
Chikitsa-Ayurvedic treatment
Samana
Lepana with soolaharadravyas
Parisheka with soolaha-sothahara dravyas
Upanaha with Vaataharadravyas
Sodhana
Sneha (Abhyanga)
Sweda (Potalisweda)
Vasti
Virechana
Raktamokshana
Commonly used Ayurvedic medicines for
Maharasnadi kashayam
Rasnasunthyadi kashayam
Amruthotharam kashayam
Rasnerandadi kashayam
Amruthaguggulu
Kaisoraguggulu
Guggulutiktaka ghritham
Vatagajankusha Ras
Shadpala Ghritham
Home remedies for De Quervain’s tenosynovitis
Pain medications to manage the pain.
The RICE mnemonic is helpful, especially when the pain if injury happens:
Rest: Rest the joint, take a break from activities involving the affected joint.
Ice: Applying ice pack locally
Compress: A compression bandage can help prevent swelling and help alignment. It should not be too tight and should be removed at night.
Diet and behaviour
- To be avoided
Heavy meals and difficult to digest foods – cause indigestion.
Junk foods- cause disturbance in digestion and reduces the bioavailability of the medicine
Carbonated drinks – makes the stomach more acidic and disturbed digestion
Refrigerated and frozen foods – causes weak and sluggish digestion by weakening Agni (digestive fire)
Curd – causes vidaaha and thereby many other diseases
- To be added
Light meals and easily digestible foods
Green gram, soups, sesame oil.
Ragi products
If having good digestive power, have milk and milk products except curd
Freshly cooked and warm food processed with cumin seeds, ginger, black pepper, ajwain etc
Behaviour:
Protect yourself from very hot & cold climates.
Better to avoid exposure to excessive sunlight wind rain or dust.
Avoid lifting heavy weights and other vigorous physical activities.
Avoid excess physical exercise, continued sitting and a sedentary lifestyle
Maintain a regular food and sleep schedule.
Practise frequent movements of fingers while working
Avoid holding or forcing the urges like urine, faeces, cough, sneeze etc.
Yoga and Pranayama
Vigorous exercises are not allowed in very painful conditions.
Only stretching, moderate walking, and mild cardio exercises are advised
Sookshmavyayama of Sandhi’s
Gomukhasana
Research papers
https://www.jaims.in/jaims/article/view/1996
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