Mark: Hi, it's Mark from Top Local. I'm here with Adam Mann of Insync Physio in Vancouver. How are you doing Adam?
Adam: Doing well. How are you doing Mark?
Mark: Good. So we're going to talk about something really a bit bizarre, but very common I think, or more common, perhaps texting disease or the dequiverians syndrome. What is this?
Adam: Dequiverians syndrome is basically a tendonitis of the thumb and so it can be quite painful to the point where it's debilitating. And I was going to talk about a client who is a waitress and also a guitarist. And so she was using her thumb a fair bit to strum and it got to the point it started as like a nagging ache, but then she was carrying coffee pots to her customers and she was constantly turning that pot over. She just felt extreme pain to the point where she almost wasn't able to hold onto the pot.
And you said it, it's actually kind of nicknamed in the medical field as the texting disease, because when you're using your thumb a lot to text, which we all do nowadays, it's an overuse injury. So it can typically cause inflammation of the muscles on the outside of the thumb.
Mark: So how do you go about assessing this and determining what exactly is going on?
Adam: Yeah. So in this case, a big clue is pain location and then we do a thorough orthopedic assessments. We looked at her grip strength. We looked at her wrist range of motion. We also looked at her thumb movements. We checked the ligaments and bones in the area, and then we found where the inflammation was. And there's a couple of special tests, which stress that area. So we gently perform those tasks and were able to find out that there was some inflammation in the tendon called the extensor pollicis longus, and at that point we had a diagnosis.
Mark: So, how did you go about treating, I guess does it vary from the first treatment onwards or how did that protocol work?
Adam: So a lot of this is education because it is an overuse injury. So we explain how to stretch some of the muscles in the hand that might be excessively tight when strong, and then how to strengthen the muscles that were aggravated in a safe manner. So the idea is that the thumb muscles on the outside of the hand are not strong enough to handle the load that she's putting in on it.
So there is a period of rest. And then, eventually we have to increase load capacity so the tendon can handle that load. First session, though, we definitely did some gentle isometric contractions, which are just contractions without movement of the inflamed tissue. And that really did take the pain away.
So there is some research that shows that isometric contractions can reduce pain or have an analgesic effect. The other thing we did since she was actually off work, she wasn't able to carry coffee and we all know how grumpy we get when we don't get our coffee, we taped her thumb. So we restricted range of motion into the painful direction, so she could actually work and she could trust herself that she wasn't going to stress the thumb in any way and be able to lift things.
We taught her a couple of stretches of the thenar eminence or those tight muscles in the front, in the palm part of the hand, in here. And together that was our first treatment basically.
Mark: So future sessions, how did it progress from there?
Adam: Yeah. So again, just a bit of load management. We start with kind of increasing the intensity of the isometric contractions. We start to make sure that we address some of the deficits that we found in grip strength. So we found that she was a lot weaker, even in her dominant hand in terms of grip strength. And then we taught some more advanced thumb strengthening exercises with movement and that sort of thing. And we were able to increase her amount of time without the tape on her hands. So she could start working without tape. And that was really helpful.
Mark: And how is she doing now?
Adam: Well, she's playing guitar. I don't think she has any shows due to COVID-19, but, she's working and she has no pain. So we were able to get this problem under control pretty quickly.
Mark: Well, allow me to throw a curve at you. This is something that I have. Oh, are these things any good?
Adam: Well, I would say certainly they're good. One of, interestingly enough, I just read a study that shows that grip strength, especially for elderly females, not necessarily you Mark, is one of the best indicators of longevity. So grip strength as we get older is really important. And so if you're working on your grip strength I'm impressed.
Mark: So if you're having any issues with your hands from texting too much, it might even be bothering your neck a little bit.
Mark: Insync Physio in Vancouver. You can book Adam Mann online at insyncphysio.com. They have two offices, one in Vancouver and if you want to talk to human being (604) 566-9716 is in Vancouver or in North Burnaby, six Oh four, two nine eight four eight seven eight to book. You have to book, they're always busy. Adam's always busy. He's an expert in this kind of stuff, but he'll get you feeling better and back doing all your favourite activities as soon as possible. Thanks Adam.
Adam: Hey, have a good day. Keep on working out that grip strength.