What exercises are recommended for De Quervain's (De Quervain's tenosynovitis) and carpal tunnel syndrome?

Exercise Recommendations for De Quervain's Tenosynovitis and Carpal Tunnel Syndrome

Regular exercise is strongly recommended for patients with De Quervain's tenosynovitis and carpal tunnel syndrome to improve pain, function, and quality of life. 1

General Exercise Principles

• Frequency: Exercise 2-3 times per week for each affected area 1, 2
• Duration: Aim for at least 150 minutes of moderate-intensity exercise per week 1
• Intensity: Progress gradually from low to moderate intensity 1
• Format: Both individual and group exercises are beneficial, with a slight advantage for group settings 1

Specific Exercises for De Quervain's Tenosynovitis

Strengthening Exercises

1. Isometric Thumb Extension:

   • Place thumb in neutral position
   • Apply resistance against a stable surface
   • Hold for 10-30 seconds
   • Perform 3-5 repetitions daily
   • Progress from low-load to high-load as tolerated 3

2. Thumb Range-of-Motion Exercises:

   • Gentle thumb abduction/adduction
   • Thumb opposition (touching thumb to each fingertip)
   • Perform 10 repetitions, 3 times daily

Manual Therapy Techniques

• Mobilization With Movement (MWM):
  • Passive radial glide of the proximal carpal bones combined with active thumb and wrist movement
  • 3 sets of 10 repetitions 4

Specific Exercises for Carpal Tunnel Syndrome

Nerve Gliding Exercises

1. Median Nerve Glides:

   • Start with wrist in neutral position
   • Progress through a sequence of hand positions:
     • Make a fist
     • Extend fingers
     • Extend wrist
     • Extend thumb
     • Gently rotate forearm
   • Hold each position for 5-7 seconds
   • Perform 5-10 repetitions, 3-5 times daily

2. Tendon Gliding Exercises:

   • Progress through five hand positions:
     • Straight hand
     • Hook fist
     • Full fist
     • Tabletop position
     • Straight fist
   • Hold each position for 5-7 seconds
   • Perform 10 repetitions, 3 times daily

Strengthening Exercises

• Grip Strengthening:

  • Squeeze a soft ball or therapy putty
  • Hold for 5 seconds
  • 10-15 repetitions, 2-3 times daily
  • Progress resistance as tolerated

• Wrist Strengthening:

  • Wrist flexion/extension with light weights (1-3 lbs)
  • 2-3 sets of 10-12 repetitions
  • Perform 2-3 times weekly 2

Complementary Approaches

For De Quervain's Tenosynovitis

• Thumb Spica Splinting: Use in combination with exercises, especially during acute phases 5, 6
• Activity Modification: Avoid repetitive thumb and wrist movements that exacerbate symptoms

For Carpal Tunnel Syndrome

• Wrist Splinting: Use neutral wrist splints, particularly at night
• Ergonomic Modifications: Adjust workstation and tool usage to maintain neutral wrist position

Exercise Progression

1. Acute Phase (0-2 weeks):

   • Focus on gentle range of motion
   • Use splinting for protection
   • Avoid aggravating activities

2. Subacute Phase (2-6 weeks):

   • Add light strengthening exercises
   • Gradually increase repetitions and resistance
   • Begin nerve/tendon gliding exercises

3. Functional Phase (6+ weeks):

   • Progress to functional strengthening
   • Incorporate task-specific exercises
   • Gradually return to normal activities

Important Considerations

• Pain Monitoring: Exercise should not significantly increase pain; mild discomfort during exercise is acceptable, but pain should not persist more than 1-2 hours after exercise
• Consistency: Regular, consistent exercise is more effective than sporadic intense sessions 1
• Professional Guidance: Initial instruction by physical or occupational therapists is beneficial for proper technique 1
• Combination Therapy: Exercise is most effective when combined with other treatments such as splinting and activity modification 5, 6

Exercise programs should be continued even after symptom resolution to prevent recurrence, with a gradual transition to a maintenance program of 1-2 sessions weekly.