Logging and de Quervaine Tenosynovitis

Morgan Becker, B.S., OT/S
Johnson & Wales University
Occupational Therapy Entry-Level Doctorate

Have you ever been operating a joystick while working a machine and experienced pain or swelling at the base of your thumb? Maybe even coupled with a “sticking” sensation when you move your thumb and wrist? Well, those symptoms might be caused by de Quervaine Tenosynovitis (DQT).

DQT is a repetitive-use injury of the wrist and thumb that causes a tendon in the wrist to become trapped. Once this tendon becomes entrapped, performing everyday work tasks such as operating all types of joysticks, doing maintenance on machines, or any task involving the thumb and surrounding wrist area become painful and potentially unbearable. Possibly affecting you at home in cases such as not being able to hold wet dishes or difficulty picking up a small child.

If this description is relatable to you, there is a simple test that can be performed to help indicate the presence of DQT. It is called the Finkelstein’s test. To perform this, simply close your fist around your thumb, orient your fist so your thumb knuckle is pointed up, and then extend your fist toward the floor. If the motion causes a painful feeling in the wrist below the thumb, this could mean DQT. This information is not meant to self-diagnose, rather to provide you more information to have clear communicate with your primary care physician (PCP).
If you or someone you work with is experiencing signs of DQT, don’t wait to get evaluated; prolonging treatment may lead to surgery and a longer road to recovery. Schedule an appointment with your PCP as soon as symptoms appear to avoid losing function in your thumb completely.

Common treatments for DQT include taking anti-inflammatories, receiving corticosteroid injections, and splinting with a thumb spica brace. Although the brace must be worn consistently in order to be effective. In severe cases, surgery to release the trapped tendon is the only option. Recovery is typically two weeks of minimal usage, and the stitches are removed at the end of this period. After the initial recovery period, it is normal to experience swelling and tenderness at the site of the surgery for a few months.

Now to address logging with DQT; it’s your career and you shouldn’t have to change paths. In any task where pain occurs, stop the movement, and check to make sure you have your wrist in its natural position (not twisted or turned at any awkward angle). In addition, adaptive equipment and adaptive techniques can support you on the job. Equipment such as using a thumb spica brace during painful tasks, making handles on levers larger to allow for easier grip, or adding an armrest so your wrist isn’t strained while performing the movement are examples of adaptive equipment. Other options could be adaptive techniques. This could be as simple as making sure you don’t skip breaks; these are vital to reducing your risk of musculoskeletal injuries and keeping you physically able to work your job. Additionally, refer to the picture in this article for common stretches to help with DQT. Try these stretches for 10-15 reps, or hold for 10-15 seconds depending on the stretch, and make sure to do at least two sets. If you have been diagnosed with DQT and are still having trouble on the job, ask your PCP about a referral to occupational therapy to help you obtain adaptive equipment and perform your best at your job and at home.

As an additional resource, contact Maine LogAbility for more information on adaptive equipment for your job, at 1.800.287.1478.