Conservative Management of DeQuervain's Tendinopathy With an Orthopaedic Manual Therapy Approach Emphasizing First CMC Manipulation: A Retrospective Case Series

DeQuervain's tendinopathy (DQT) is a musculoskeletal disorder that limits hand function of affected individuals. Management of DQT can include splinting, activity modification, medications, corticosteroid injections, Physical Therapy, and surgery. There is limited evidence to support the combination of manual therapy and exercise interventions within an Orthopaedic Manual Physical Therapy (OMPT) approach when managing patients with DQT. Three patients identified with DQT underwent a multi-modal treatment regimen including carpometacarpal (CMC) thrust and non-thrust manipulation, end range radiocarpal mobilization, mobilization with movement (MWM), strengthening exercises, and grip proprioception training. Outcomes were assessed using the numeric pain rating scale (NPRS), Jamar hand dynamometer grip strength, and the Quick Disabilities of the Arm, Shoulder, and Hand (Quick DASH) questionnaire. These measures were administered at baseline and discharge.

Inclusion criteria

Five or more items present on the DQT screening tool devised by Batteson et al.:

• Pain over the radial styloid
• Tenderness over the dorsal thumb
• Pain with active thumb flexion
• Localized swelling over the thumb
• Positive Finkelsteins test
• Thickening of the tendon sheath of the first dorsal extensor compartment
• Pain with resisted thumb extension.

Exclusion criteria

• Cardiovascular disorders
• Non-musculoskeletal complaints
• Auto-immune disorders
• Patients who had received previous treatment for their condition