Modern society requires a great deal of repetitive thumb use, especially from texting on mobile devices. A recent study investigated the frequency of text messaging among university students and found that close to half these students were sending an average of 50 text messages per day.(1) Many of them were experiencing thumb pain and tested positive for tendon pathology of the thumb.
These same stresses that plague mobile device users also plague many massage therapists, because techniques often involve constant or repetitive use of the thumb. A frequent result of thumb overuse is a condition called de Quervain’s tenosynovitis.
This condition can range from a minor irritant to a serious impairment in your ability to work. Failure to resolve chronic overuse disorders like tenosynovitis has led numerous massage therapists to leave the profession from occupational injury. Understanding how this condition develops helps create effective strategies for identifying it and successfully resolving it when it occurs.
Most of the muscles that operate the hand and fingers have their muscle bellies in the forearm with long tendons that extend into the hand and fingers. These long tendons cross numerous joints and must be capable of making significant bends because of the multiple articulations.
These distal extremity tendons transmit their forces most effectively when bound closely to the joints they cross. Connective tissue retinacula, such as that shown in Figure 1, are what bind the tendon to the joint. In order to reduce friction between the tendon and the retinacula, tendons of the distal extremities are encased within synovial sheaths. The tendon must be able to slide back and forth smoothly within the synovial sheath for effective and pain free movement.
Repetitive motion or excessive stress on the tendon causes the development of fibrous adhesions or inflammatory reaction between the tendon and the surrounding sheath. This inflammatory reaction with fibrous development is called tenosynovitis. There are two key muscles of the thumb most frequently affected. They are the abductor pollicis longus and extensor pollicis brevis. The involvement of these two tendons was originally described by Fritz de Quervain, so he lent his name to this condition.
These two tendons are used extensively for operation of small mobile devices. In fact, this condition is now frequently referred to as Blackberry thumb or gamer’s thumb. The condition occurs frequently in massage therapists because of repetitive use of the thumb as well as fatigue from constant engagement of these two muscles performing various massage techniques.
Pain is felt most commonly at the base of the thumb and it is relatively easy to reproduce the pain by palpating the region shown in Figure 2. Another commonly used evaluation procedure is called the Finklestein test. In this procedure the thumb is held across the palm and fingers are wrapped over the top of the thumb while the hand is moved in ulnar deviation. If this motion reproduces the pain near the base of the thumb it is commonly indicative of tendon dysfunction such as might exist in tenosynovitis.
De Quervain’s tenosynovitis is most effectively treated by attempting to reduce fibrous adhesions between the tendon and its surrounding synovial sheath. Deep friction of the affected tendons is particularly helpful for achieving that goal. The friction treatments are most effective if they are performed while the tendon is on stretch so that it is pulled taut. It is also helpful to treat the bellies of the abductor pollicis longus and extensor pollicis brevis muscles so chronic hypertonicity in these muscles does not apply further tensile overload to the tendon.
Constant text messaging has become such an integral part of many people’s lives. If you have clients that are showing symptoms of de Quervain’s tenosynovitis, you cannot only help them with massage, but teach them how to do this themselves at home on a regular basis to reduce the cumulative stress that can further aggravate the condition. Similarly, it is very beneficial to perform self-massage of these affected tendons on your own wrist and hand to prevent the condition from developing into a career-shortening injury.
1. Ali, M., Asim, M., Danish, S. H., Ahmad, F., Iqbal, A., & Hasan, S. D. (2014). Frequency of De Quervain’s tenosynovitis and its association with SMS texting. Muscles, Ligaments and Tendons Journal, 4(1), 74–8.