I have developed a moderate pain in the extensor tendons of the thumb: abductor pollicis longus (APL) and the extensor pollicis brevis (EPB). The pain became intense after a bouldering session on plastic. I was diagnosed with . I stopped climbing at the gym four weeks ago, and since then have only done a couple of moderate trad climbs with my hand taped to avoid any stretching of the tendons. I also avoided using my thumb. The treatment has included taking ibuprofen, and multiple sessions with the PT using a steroid gel applied with ultrasound targeting the area. I have applied ice multiple times a day and wear a removable splint often. The problem is slowly getting better, although in the morning the pain is a lot more intense. Is there anything else I can do to help speed healing? Should I not climb until all the pain in the tendons is completely gone?
Ernesto Trujillo, Fort Collins, Colorado
De Quervain's is an inflammatory disorder of the synovial sheaths that the APL and EPB tendons glide through. Ironically, the sheaths are there to reduce frictional force, but when aggravated, they become inflamed.
I have to say I am not a fan of splinting for any condition unless absolutely necessary. Like U.S. foreign aid, there is much hoopla, followed by enormous problems and infrequent good outcomes.
I have never splinted someone or had recovery go beyond a couple of weeks. Splinting should not be frontline, but is certainly a worthy arrow if all else fails to hit the mark.
Likewise, pharmaceutical intervention is not the vanguard of medicine for musculoskeletal disorders. That said, cortisone would be of assistance, at least in the short term. This assumes that you've cut out aggravating activities, and addressed musculoskeletal factors, and that it is minor aggravations that are maintaining the inflammation.
For inflammatory conditions, ultrasound is pointless. It is assumed to have thermal and mechanical effects on the target tissue, and supposedly increases local metabolism, circulation and tissue regeneration. Maybe it does, but not significantly. Certainly it does not have some mystical, difficult-to-comprehend property that you, the na¿ve consumer, should be happy to pay for. Ultrasound is, however, a beautifully constructed placebo, used by roughly 95 percent of physical therapists. Placebo! Cocaine would be equally helpful, more enjoyable and competitively priced depending on U.S. relations with Colombia.
De Quervain's is usually a repetitive-strain type of injury, arising after several hours of aggravating activity. Climbing is not typically a catalyst, though it may maintain the injury. Pinches often exacerbate it; most everything else does not. Ironically, trying to guard the thumb by lifting it out of the way can cause more aggravation than using it.
Gaming consoles, some computer mouses, using a wrench for hours, and other repetitive activities can initiate the pathology, but it is easily maintained by activities that would not start the process.
In De Quervain's the extensor muscles are likely to become chronically inflamed and rather pissed (that's a diagnostic term). A stern massage often helps, as it does for many musculoskeletal conditions. Heat on the muscle bellies in the upper forearm, and ice over the lower inflamed area can be helpful.
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