De Quervain’s treatments continued…

Follow up on my client with this painful inflammation of the Abductor Pollicis Longus tendon.

Third treatment (weekly intervals) we arranged the appointment to better accommodate her baby being present which gave us more time than on the second occasion.

The client reported that after each of the previous treatments she felt significant relief for about 2 days. It is really important to ascertain this feedback as accurately as possible. In a best of all worlds scenario, the length of noticeable effect determines optimal timing of the next treatment. If I was able to treat this lovely young mum every 3 days I know our results would progress much faster. So often these decisions are driven by finances and other practicalities rather than optimal treatment regimes.

With more time I was able to treat both arms using the special techniques from the Therapy 1 course. I did use some shoulder specials but only to look for the spots that had been tender on the previous visits. They were considerably better so I was then able to move onto the more distal areas for the rest of the time. If these shoulder spots had still been tender I would have remained working on the proximal areas.

I cannot stress enough how important it is to address proximal issues first when doing lymphatic work. It’s so tempting to go straight to the problem area and spend all the time there – and sometimes difficult to get the client to understand why we are not doing that either. But my own experience and that of the many therapists that communicate their results to me is that it is always a mistake to skip over the proximal treatments. This applies just as much for the skeletal-muscular work we do as it does to lymphoedema.

As you can imagine the areas over the thumb tendon were the most painful and required the longest treatment time. Remember that our palpation is only to find the painful areas, not to keep pushing on them, so I only needed to touch these spots once to find them. Then with such and acute condition I was very careful to work pain free, checking routinely during treatment that the pressure is not reproducing any pain.

On the second treatment I had used lymph tape to support the tissue around the tendon after testing a small piece of tape on her inner elbow. The hand therapist had tried taping but the client had a bad reaction to the adhesive causing a rash over the affected area. The reddened area of skin persisted for about 2 weeks, not very conducive to reducing inflammation! If you are using a good quality lymph tape the adhesive will be hypoallergenic and can usually be tolerated by people who might react to other tapes. I use a product from the Netherlands called Cure Tape which is available in Australia from Haddenham Health.

My client reported that the previous taping had felt good, like it was supporting the thumb a little but that it hadn’t lasted very long. (Hands are washed so frequently its often hard to keep the tape on them). I spent a bit of time giving her instruction in taping both thumbs and let her put the tape on the second thumb herself. The trickiest thing about getting tape onto this condition is that in order to fully stretch the skin under the tape they need to abduct the thumb across the palm – the most painful movement for them to do!

The tape is applied along the line of the abductor tendon and muscle on the forearm and then divided either side of the tendon as it emerges from the retinaculum.

Thumb postiton  for applying posterior tape strip, wrist deviated radially, thumb flexed at both joints.
Thumb position for applying posterior tape strip, wrist deviated radially, thumb flexed at both joints.

The thumb must be flexed across the palm as much as possible for the posterior strip. Then both the wrist and the thumb are extended as much as possible for the anterior strip.

Thumb position for anterior tape strip application.
Thumb position for anterior tape strip application.

It is really important not to stretch the tape during application, so before rubbing it a little to activate the adhesive check that in the neutral postition there is good wrinkling of the tape and that you can’t see any catching of the skin underneath.

Make sure the tape is not stretched during application and that the skin is not caught in wrinkles underneath the tape.
Make sure the tape is not stretched during application and that the skin is not caught in wrinkles underneath the tape.

Since I was leaving the next day to come to Myanmar I was very focused on teaching my client to do self drainage and apply the tape herself while I am gone so I forgot to photograph the tape. These photos are me applying it to myself in my hotel room here and taking the pictures with my phone so sorry if they are not the best angles!

I wrote about this condition briefly in my last MLD newsletter and a couple of therapists replied telling me of the great successes they have had with treating DeQuervains. I’ve asked them for permission to use their cases in this blog so hopefully I will post a few more stories about this in the near future.