How Does a Splint Help de Quervain’s Synovitis?

Whether you’ve been diagnosed with de Quervain’s synovitis, seen someone wearing a de Quervains synovitis splint, or have begun suffering some pain at the base of your thumb, you may be in search of more information about the condition and whether a splint can help.

The short answer is that a splint can help alleviate some of the symptoms and give the inflamed tissues involved time to heal. While surgery is a possible solution, it is the most extreme, and a splint can, in many cases, yield the same results without surgery.

To understand how a splint helps, we’ll need to explore what de Quervain’s synovitis is.

Mommy Thumb

Just like people who don’t play tennis can get tennis elbow, people who aren’t moms can develop this malady, which has a couple of different names:

• Mommy thumb
• Blackberry thumb
• De Quervain’s synovitis
• De Quervain’s stenosing tenosynovitis
• De Quervain’s tenosynovitis

Regardless of what you call it, de Quervain’s synovitis results from swelling of the tendon and other tissues at the base of the thumb. It occurs when the tendons swell, but it can also arise when swelling of the synovium occurs, hence the affliction’s name. 

The synovium is a fluid-filled lining that acts as a lubricant of sorts for the tendons. It allows them to move in and around joints with ease, but if the membrane swells, movement can become painful.

Inflammation of the synovium or the tendon on the thumb side of the wrist causes pain in that area, which can radiate to the thumb tip or in the other direction, up the forearm. The pain usually increases when the thumb or wrist is flexed or otherwise engaged.

Many people experience visible swelling in the area, and attendant tenderness is common. 

The inflammation results from repetitive motion and can be incited by fluid retention that expecting mothers often experience in the third trimester. This fact, coupled with the statistic telling us that de Quervain’s synovitis is ten times more common in women than in men, led to the “Mommy thumb” moniker.

In the early days of cellphone technology, many Blackberry users also developed de Quervain’s stenosing tenosynovitis due to the repetitive thumb motions associated with typing messages on the device, so the malady was known as Blackberry thumb for a time.

Risk Factors

While anyone can conceivably suffer any medical condition, risk factors make it so that some people are more likely than others to contract a specific illness or develop a certain injury.

• Employees working jobs that require wrist-twisting movements on an ongoing basis risk developing this repetitive motion-related condition.
• Hormone levels and fluid retention related to pregnancy increases the risk.
• Individuals between the ages of 30 and 50 constitute the largest group of de Quervain’s synovitis diagnoses.
• Lifting infants, changing diapers, and manual manipulation of the breast for breastfeeding can contribute to developing de Quervain’s. 
• Women are at higher risk just by being women, who are far more likely than men to get this diagnosis.

Splinting and Other Treatments

The most common and least invasive treatment for de Quervain’s tenosynovitis involves a splint. Several splint styles exist, each with a different level of movement restriction, as that’s the best thing for the condition— immobilization. 

The concept behind splinting lies in keeping the thumb extended and the wrist in a neutral position. The two tendons involved in de Quervain’s are the extensor pollicus brevis (EPB) and abductor pollicus longus (APL) tendons. The muscles associated with these tendons flex and move the thumb. Overuse of these muscles can cause friction, resulting in tendon inflammation.

A splint can minimize, restrict, or eliminate the movements of the thumb to allow the swelling to dissipate and the affected area to heal. Varying designs populate the world of de Quervain’s splint, but effectively addressing the inflammation involves splinting the thumb. Patients need more than a wrist brace.

A Wrist Splint with Thumb Spica holds the thumb away from the hand and keeps it still. The remaining fingers are unimpeded, so the wearer doesn’t lose effective use of the entire hand.

And the level of wrist support or immobilization is adjustable, as patients can insert aluminum stays in the splint to further restrict wrist motion.

A splint helps de Quervain’s synovitis patients heal by decreasing or eliminating the movement and engagement of the EPB and APL tendons. When allowed to rest, the inflammation often goes away, and the pain associated with movement does, too.

More Invasive Remedies

While taking pills isn’t as invasive as surgery, it’s still putting something in your body. So medications are more invasive than wearing a splint.

But ibuprofen is a proven remedy for pain and inflammation, and taking it can at least help with the pain associated with de Quervain’s, if not eliminate swelling altogether.

Cortisone injections can help treat the symptoms, though they do not generally heal the injury. Still, a de Quervain’s patient suffering great pain would welcome even temporary relief. 

Finally, surgery is a possibility. Roughly half of all de Quervain’s synovitis patients eventually require surgery, but this large number may result from people ignoring symptoms or just hoping it goes away.

Surgical treatment involves relieving pressure on the tendons by severing the extensor retinaculum. This is a band of fascia over the wrist. If you wear a watch, picture the extensor retinaculum directly under it, as it resembles a watchband in placement and width.

The band holds the wrist tendons in place, but if any tendons swell, they have difficulty moving through their paths. Severing the extensor retinaculum allows the tendons to breathe, in a manner of speaking, and relieves the pressure on them.

Wrist immobilization during post-surgery recovery allows those freed tendons to heal and rid themselves of the inflammation. 

While this particular surgery isn’t terribly invasive (and can be done endoscopically), it’s still a more serious undertaking than wearing a splint.

Physical Therapy

Physical therapy can be an invaluable part of the treatment of and recovery from de Quervain’s tenosynovitis. Your doctor may recommend it before, during, and after using a de Quervain’s synovitis splint, getting cortisone injections, or undergoing surgery.

The physical therapist will evaluate your wrist movements, especially if your case of Blackberry thumb arises from a repetitive motion job. The therapy can involve learning safer ways to make those movements so as not to cause a recurrence of de Quervain’s, as well as stretches and exercises. 

These exercises aim to build strength in the wrist and thumb muscles associated with the swelling and stretching aids in building and maintaining flexibility, which can lead to an increased range of motion in the thumb.

Final Thoughts

The pain of any repetitive motion injury can be exasperating since the repetitive motion that caused the problem in the first place usually isn’t one we can simply stop doing. It may be part of employment, or it may come from taking care of our children.

Effective treatment of wrist and thumb pain related to Mommy thumb can come from using a de Quervain’s synovitis splint. The splint holds the thumb still and extended. It also keeps the wrist relatively still. Doing so allows the tendons in those areas time to heal, which can alleviate the inflammation which causes pain.