Running head: DE QUERVAINS DISEASE

De Quervains Disease
Orah Kabaei
Touro University Nevada

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Occupational Profile

The Client
Rachel is a 60 year old female, living with her husband of 40 years. Not too long ago, she
and her husband relocated to Henderson, Nevada from Northern California. She is a semi-retired
nurse who used to work in the Intensive Care Unit while in Northern California. Occasionally,
she travels back to Northern California to work for a plastic surgeon. Rachels husband is a
computer specialist for a security system and travels often for work, while Rachel stays at home.
Rachel describes herself as a professional housewife. She has a son and a daughter who both
live in California. Her daughter recently gave birth to a baby boy, making her a grandmother.
Sarah takes pride in being a grandmother, and is excited that another one is on the way! Since
the second grandchild will be a planned caesarian, she hopes that she will recover from her hand
injury to ensure that she will be able to help her daughter to the best of her ability. In her free
time, Rachel enjoys golfing and gardening. Since her move to Henderson, she has been very
busy with decorating her new home
Reason Seeking Services & Concerns
After taking the Finkelsteins test, results indicated that Rachel has a diagnosis of de
Quervains tenosynovitis in her right hand. Rachel is left hand dominant and about a year ago,
Rachel hurt her left hand. She did not offer the diagnosis to the left hand injury, but did mention
that her anatomical snuff box was irritated and she had to undergo an operation. The recovery
period was quite lengthy and to compensate, she started using her right hand. Just this past July,
her right hand developed classic symptoms of de Quervains tenosynovitis. Rachel believes that
the injury first took place when she hit her hand while attempting to turn the key in the door.
Handling her grandson, and the packing and unpacking she has done from Northern California to
Nevada has exacerbated the problem. Repetitive stress on the thumb and index finger has made
the sheath inappropriately tight, to the point where the tendons cannot slide through. After

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results yielded positive for de Quervains tenosynovitis, her surgeon has recommended surgery to
release the first dorsal compartment of her hand. Rachels main reason for seeking services
under a certified hand therapist is to avoid having to receive surgery through the use of
conservative treatment. Although she believes chances are she will still need the surgery, she
notices improvements through therapy and hopes this will buy her some time. Activities of daily
living (ADLs) and instrumental activities of daily living (IADLs) that are of concern to her are
things that she usually does as a professional housewife. This includes cooking for her husband
when he is in town, laundering and folding clothes, gardening and taking care of her grandson.
Pain in her right hand seems to always get in the way of engaging in the things she loves to do,
wants to do and is required to do. Rachel has received six steroid injections over the past six
months and while this has provided her with temporary relief, the anatomical buildup of scar
tissue in the tendons of the affected area prevents the steroid from working any more than it has
already. Rachels surgeon has recommended a thumb spica orthosis to immobilize the affected
area and prevent further swelling. Rachel would like to have one fabricated by the certified hand
therapist.
Successful Areas & Barriers to Occupational Engagement
Rachel did not share any occupations that she feels successful in. Since her injury, Rachels
productivity has diminished significantly. At the given moment, Rachel has not been able to
work as a nurse for the plastic surgeon since traveling back to Northern California has been very
difficult. Meal preparations have been taxing on her hand and she would like to find a solution
to this. When her grandson is in town, Rachel enjoys watching him, but states that she
experiences a lot of pain when lifting him up. Pain is also exacerbated when she lifts dishes,
pulls laundry out of the wash, and is folding laundry. Overall, Rachel placed emphasis on the

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fact that placing weight on her wrist causes an excruciating amount of pain which inhibits
engagement in daily routines.
Clients Occupational History
Rachel used to work as a nurse in the Intensive Care Unit. She is now semi-retired and
has not been working in the past month. Rachel reports having several medical complications
prior to injuring her hand. She describes her skeleton system to be a mess. Both of her hips
have been replaced and she suffers from arthritis due to overuse. Rachel also mentioned having
neck and back problems, where she managed to avoid surgery by working with a physical
therapist to address problems associated with those areas.
Not too long ago, Rachel had a ligament reconstruction tendon interposition in her left
hand. Prior to the procedure she had difficulty utilizing fine motor skills to complete tasks such
as closing buttons. Now that she has had her trapezium pulled out, she feels like she is healing
normally. However, she still complains of having difficulty with opening jars, using the lawn
mower, gardening and golfing. Her experience during the recovery time post operation was
painful and lengthy. This is one factor that influences her decision to try conservative treatment
in an attempt to postpone surgery. She values her independence and would like to avoid hand
surgery on her right hand, if attainable.
Clients Values and Interests
Through her description of her medical history, it was evident that Rachel has a great sense
of humor and an optimistic approach to battling her medical complications. She values
independence and stated that she would like to live life to the fullest, regardless of the pain she is
experiencing. She is interested in addressing problems through conservative treatments before
turning to surgery.
Clients Daily Life Roles
Through her brief description of her daily life roles, it is evident that Rachel takes pride
in being a housewife and a grandmother. When her husband is home, she enjoys making him
meals. Since her move to Nevada, her house has been under a construction claim. She chose not

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to keep her housekeeper and does most of the housework on her own. As the professional
housewife, Rachel takes responsibility for making the beds, folding the laundry, and taking out
the garbage. She admits that she should hire someone to help her with these chores. She also
shares that she uses her hands a lot doing things she enjoys such as golfing, gardening and lifting
her grandson when he is nearby.
Other than retiring from her position as a nurse in the Intensive Care Unit, Rachels
pattern of occupational engagement has remained the same. Using the Visual Analog Scale
(VAS) she rates her pain to range from 4 to 7, yet refuses to allow this from engaging in the
things she would like to do.
Clients Priorities & Desired Targeted Outcomes
Rachels primary goal is to reduce the amount of pain she is experiencing in the radial
side of her right hand when engaging in occupations that are meaningful to her. She placed
much emphasis on trying conservative treatment in an attempt to push off having to receive
surgery for her de Quervains tenosynovitis. She stated that her main concern revolved around
recovering prior to the birth of her next grandson to ensure that she will be of assistance to her
daughter since her daughter will be delivering her baby via caesarian. It is quite apparent that
her role as a grandmother is of umpteen importance to her, and her injury is a potential barrier in
this meaningful role.
Meal preparation and home maintenance are other areas that Rachel would like to engage
in without experiencing an excruciating amount of pain. Rachel is very determined to live life to
the fullest and hopes that conservative care and a thumb spica splint fabricated by a certified
hand therapist will minimize her pain and allow her to complete the occupations that are
meaningful to her.
Occupational Analysis
Context/Setting

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Rachel was seen at Select Physical Therapy to be treated by Pia, a registered and licensed
occupational therapist and certified hand therapist. Hand therapy focuses on the rehabilitation of
the hand and upper limbs to enable function after an accident, disease, or repetitive stress on an
area. In this setting, use of physical agent modalities (PAMs) such as ultra sound, heat packs,
iontophoresis, and fluidotherapy are very common. Therapeutic activities are typically simulated
and take a biomechanical approach. The clinic includes a staff of physical therapists, too,
allowing for clients to participate in concurrent treatment if required.
Activity & Clients Performance
In the 60 minutes Rachel participated in occupational therapy under a certified hand
therapist, interventions implemented consisted mainly of PAMs such as use of a hot pack,
ultrasound, soft tissue immobilization, therapeutic exercises and iontophoresis. Therapeutic
ultrasound is a modality used to improve tissue extensibility, to assist with pain relief as well as
promote healing of wounds and tendons, through frequency waves. Non-thermal therapeutic
ultrasound (3 MHz) is typically used for de Quervains tenosynovitis, and was the duty cycle
used on Rachels affected area (Goel & Abzug, 2015). Following therapeutic ultrasound, soft
tissue massage was performed along the first dorsal compartment tendons to relax tight
musculature that can increase pain.
Rachel was then instructed to complete therapeutic exercises of lifting 2 pound weights
on a ramp. The goal of therapeutic exercises is to enhance gliding of the abductor pollicis longus
and extensor pollicis brevis tendons in the first dorsal compartment (Goel & Abzug, 2015).
Rachel was asked to complete three sets of ten repetitions. The ramp held her wrist in a neutral
position to prevent further injury on the affected area. While Rachel was able to complete the

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required exercise, it was evident through her facial expression that she was experiencing some
pain. Services ended with use of the iontophoresis, a therapeutic modality used to deliver antiinflammatory medications for edema control and to stimulate healing. Iontophoresis was
delivered with dexamethasone, a medication which has been shown to be effective for pain
control (Goel & Abzug, 2015). This has been her second application, and thus far Rachel has
noticed a reduction in her pain. She believes the dexamethasone is effective and would like to
continue its use for the time being.
Rachel did not engage in any activities, and therefore was not analyzed, however,
activities that were problem areas in the context of her home were discussed with Rachel. A few
of the examples she gave were that she has difficulty pulling off fitted sheets, reaching into the
drier and folding clothes, fastening her brassiere and repetitively lifting her grandson. She
experiences pain with opening jars and using certain utensils such as can openers and shovels
when gardening, too. Meal preparation has been taken her longer to complete as well.
Key Observations
Key observations from the discussed performance of occupations indicates that activities
that place added weight on Rachels wrist cause Rachel pain. In the case of de Quervains
tenosynovitis, simultaneous thumb abduction with ulnar deviation further exacerbates the pain.
This includes activities requiring repetitive wrist movements in the described position.
Domains Impacting Performance
De Quervains disease is stenosing tenosynovitis of the short extensor (extensor pollicis
brevis) and long abductor tendon (abductor pollicis longest) of the thumb within the first
extensor compartment (Porter, 2011, p.393). The disease affects the ability of the tendon to

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glide normally through the synovial sheaths. Subsequently, tissue thickens with hypervascular
changes and causes the tendon to degenerate. Depending on the severity of the disease,
individuals such as Rachel may be referred to surgery to release the first extensor compartment.
Prior to referral of surgery, practitioners will take a more conservative approach. This involves
use of anti-inflammatory medication, steroid injections, protective splints, and limiting activities
the client may engage in.
Rachel has tried steroid injections which have provided her with temporary relief. Since
scar tissue has built up, this is no longer an option. Rachel currently is on prednisone, an antiinflammatory medication, yet is experiencing pain. Rachel is seeking hand therapy services in
hopes to determine with the certified hand therapist if there are any other conservative options
for the management of her de Quervains tenosynovitis.
Occupation is described as the daily activities in which people engage in and are
influenced by the interplay among client factors, performance skills, and performance patterns.
Domains of the Occupational Therapy Practice Framework (OTPF) that are most significantly
impacting Rachels ability to successfully engage in occupations are mostly involving body
structures mentioned earlier that are impacting her motor skills. This includes Rachels ability to
reach, grip, manipulate and coordinate objects with her hands (American Occupational Therapy
Association [AOTA], 2013). Lifting and transporting task objects is a challenge for Rachel since
added weight places pressure on the tenderness along the radial aspect of the wrist, which causes
her a significant amount of pain. Rachel easily fatigues in her hands, and demonstrates low
endurance of hand activity (AOTA, 2013). When interacting with task objects, flow of wrist
extension is limited due to thickening of the extensor retinaculum. Rachel also displays

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inconsistent rate of performance when utilizing her hands in selected occupations that require
wrist movement (AOTA, 2013).
Rachel greatly values her independence and chooses to engage in ADLs regardless of the
pain she experiences. However, there are moments when the pain is too unbearable.
Consequently, Rachel disengages from certain habits, routines and roles, disrupting her typical
performance patterns (AOTA, 2013).
Problem List
Problem Statement
1. Client is unable to lift her grandson for more than 3 minutes due to radial wrist pain
levels of > 5/10 with ulnar deviation of the hand.
2. Client is unable to complete preparation of meals in a timely manner due to pain and
decreased endurance of affected hand for repetitive work.
3. Client has difficulty fastening/unfastening her brassiere from behind due to 7/10 pain
levels in thumb.
4. Client is unable to engage in leisure activities such as golfing and gardening due to pain
levels of 7/10 when handling objects.
5. Client is unable to open and close jars due to 7/10 pain levels when pronating the hand.
During her treatment session at Select Physical Therapy, Rachel placed emphasis on taking a
conservative approach to treat her hand disease. Although surgery has been suggested by her
orthopedic surgeon to resolve her de Quervains tenosynovitis and the pain she has been
experiencing on the radial side of her wrist, she stated that she would like to postpone her hand
operation since the recovery period is quite lengthy and her daughter is expecting a second child
via caesarian very soon. Rachel hopes that skilled hand therapy services will promote recovery
and allow her to partake in her role as a grandmother and mother by assisting her daughter with

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her two grandsons. Hand therapy services include fabrication of orthosis/splints, which may be
an effective remedy to preventing further pain when taking care of her grandson. Taking a client
centered approach and prioritizing the clients concern, lifting her grandson will be the first
problem area addressed.
In addition to her role as a mother and grandmother, Rachel takes pride in her role as a
professional housewife, specifically in preparing meals for her husband when he is in town.
Rachel enjoys cooking and mentioned that she goes all out when preparing meals. When her
children are in town, Rachel makes fancy gourmet meals for family dinners. Through her
description of the steps she takes to prepare meals, it is evident that meal preparation places an
enormous amount of pressure on Rachels affected area and exacerbates pain. The complications
present with this problem statement would typically make it the first problem to be addressed,
however using clinical reasoning and considering the clients main concern for coming in for
services allows handling her grandson to take precedence. Thus, this should take priority as the
second problem area addressed.
The third problem statement addresses concerns Rachel has when fastening and unfastening
her brasserie. It can be assumed that if Rachel is having difficulties with this task, she may be
struggling with buttoning and zipping other clothing items as well. Dressing is something that is
typically done independently, and may present an inconvenience when difficult to complete
especially in Rachels case where her husband is travelling on a consistent basis and is not
always available to help her. Once this problem area is resolved, Rachel will feel more selfsufficient in the daily routine of dressing.

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The last two problem statements address leisure activities and opening jars. Rachel
expressed her interest in preparing meals in a timelier manner. Through her description of the
activity demands required of her to prepare a meal, it is evident that meal preparation will
include opening and closing jars and may be included in interventions implemented for meal
preparation. It can also be assumed that engagement in leisure activities allows Rachel a chance
to spend time away from chores and work, and is a chance for her to refresh her body and mind.
Thus, leisure activities should be addressed in this particular order. Lastly, recognition should be
given that home maintenance is not listed under the given problem statements since Rachel came
to the conclusion that it would be beneficial for her to hire help to address this area. Financial
flexibility allows her to hire extra help, as well.

Intervention Plan & Outcomes

Conservative care provided by the occupational therapist to treat de Quervains
tenosynovitis typically includes splinting, activity modification, modalities, manual treatment
and therapeutic exercise. Etiology of this disease stems from repetitive and continued strain of
the abductor pollicis tendon and extensor pollicis brevis tendon as they pass under a thickened
and swollen extensor retinaculum (Deshales, 2014). While conservative treatment will be the
first course of action to take, it is not guaranteed that symptoms will subside. Surgical
intervention will be warranted then. Nevertheless, each clients case differs and interventions
should be individualized based on the severity of the disease. To treat Rachels de Quervains

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tenosynovitis, the following goals will be addressed with interventions that will be implemented
in the treatment session.
Long-term Goal One
Client will hold grandchild with both hands with decreased wrist pain within two weeks.
Short Term goal one. With the assistance of the CHT, client will select and utilize an
appropriate splint to decrease repetitive use through immobilization of the affected area within
two treatment sessions.
Intervention one. Rachel will be educated on the benefits a thumb spica splint offers in treating
individuals with de Quervains tenosynovitis. The splint assists in pain management by
immobilizing the thumb and wrist joints, thereby preventing thumb MP joint flexion wrist ulnar
deviation. When a splint is prescribed, a forearm-based thumb spica splint that immobilizes the
joints with the wrist in neutral, 30o of thumb abduction with the thumb interphalangeal (IP) joint
free is recommended (Howell, 2008). If Rachel feels like she will make use of the orthosis, then
the certified hand therapist will fabricate one for her. She will be educated on its use, proper
application of the splint and appropriate times for use of the splint. By utilizing this approach,
the therapist will enable Rachel to hold her grandson for longer periods of time without using the
affected area since it will be immobilized by the orthosis.
Approach. This intervention approach is centered on the premise of prevention. Fabrication and
utilization of the splint will immobilize the affected area and prevent further exacerbation of the
injured area. According to Howell splinting is effective in immobilizing and resting the APL and
EPB tendons in a position to decrease the friction in the joint that can lead to increased pain and
inflammation (2012).

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Outcome. Fabrication of the thumb spica splint is a preparatory method done to the client
without the clients active participation (AOTA, 2013). The outcome hoped to be achieved
through this intervention plan will be enhancement in occupational performance by preventing
further pain on the affected area.
Short Term Goal Two. Client will demonstrate understanding of modified lifting techniques
while lifting an infant to help minimize pain within one treatment session.
Intervention two with grading options. During this intervention, the therapist will educate the
client on an alternative method of lifting an infant. The therapist will first demonstrate how to
modify lifting a child and have the client model the technique to ensure that she can incorporate
this technique when lifting her grandson. Education will be provided on proper positioning as
well as benefits of utilizing modified lifting techniques. The therapist will explain to the client
that instead of picking the child up by the arm, the child should be scooted up by lifting under his
bottom while supporting his head. The client will be instructed to keep the palm of the hands up
while lifting. This is beneficial since it redistributes the pressure that can aggravate tendons when
lifting in an L shape (fingers on babys back and clients thumb on his chest).
While it would be ideal to incorporate the clients grandson in the treatment session, this
is not possible since the clients grandson lives out of state. The therapist can demonstrate proper
positioning using a doll, and have the client model the behavior. During this intervention, the
therapist should be vigilant in ensuring that the client is keeping her wrist in a neutral position,
all the while not placing strain on the thumb and wrist. According to Papa, initial conservative
management for de Quervains tenosynovitis should consist of relative rest and activity

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modification to reduce repetitive and sustained loading on the first dorsal compartment (2012).
Utilization of this technique minimizes strain on the first dorsal compartment.
To grade the activity up, the therapist can instruct the client with verbal directions instead
of providing an additional visual demonstration. To grade the activity down, the therapist can
provide hand over hand assistance to help guide the clients hand position in making the
modification changes.
Approach. Client education and demonstration of specific strategies to modify techniques for
lifting, will be classified under the intervention approach of modification (compensation,
adaptation).
Outcome. Role competence is identified as the mechanism of outcome measurement with this
intervention. The client values her role as a grandmother and would like to be active in assisting
her daughter in taking care of her grandsons. Childrearing is classified as an IADL that includes
providing care and supervision to support the developmental needs of a child (AOTA. 2013,
S19). This IADL includes repetitive lifting, especially when toddlers and infants are involved.
Once the client incorporates modified techniques in lifting her grandson, the client will
experience less pain and allow her to engage in this IADL with ease, thus ensuring competency
in her role as a grandmother.
Long Term Goal Two.
Client will complete meal preparation activities with decreased wrist pain within two weeks.

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Short term goal three. In order to increase performance of meal preparation, the client will
identify and utilize 3 assistive devices she can utilize in meal preparations, within one treatment
session.
Intervention three. Modifying meal preparation activities through the use of assistive devices to
reduce repetitive and sustained loading on the first dorsal compartment is another intervention
that can be utilized to help the client achieve long term goals of preparing meals with decreased
pain. During this intervention, the client will participate in a cooking activity with cooking
appliances that are designed to decrease demands of tasks that involve repetitive pinch, grip or
twisting actions (Reed, 2014). Examples of devices that will be presented to the client include an
electrical can opener, adapted utensils with larger handles, vegetable choppers, jar openers and
more. The client will be provided with information on adaptations she can implement to handles
of objects, such as pots and pans, to cushion the grip. The therapists role will include education
on use of devices and the benefits consistent use will provide in preparing meals in an
appropriate time without exacerbating the affected area.
Approach. This intervention approach of modifying the equipment Rachel uses in the kitchen as
well as incorporating assistive devices guides Rachel in compensating during meal preparation
and combats the decline in endurance she has been experiencing.
Outcome. The outcomes hoped to be achieved through this intervention is improvement in
occupational performance of meal preparation and prevention of further irritation to the affected
area while engaging in meal preparation, all the while utilizing assistive equipment. After this
intervention, it is expected that the client will purchase and use equipment that she has had
positive experience with, in her own home.

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Short term goal four. Client will demonstrate an understanding of joint protection techniques
while preparing meals within one treatment sessions.
Intervention four. Rachel will participate in a meal preparation activity, all the while
incorporating proper positioning, ergonomics, and joint protection techniques. This intervention
is supported by OBrien (2007) who states Ergonomic modifications and alterations of any
repetitive activity such as lifting an infant or small child, playing the piano are required to
prevent recurrence. Meal preparation requires fine motor skills in order to grip, manipulate,
coordinate, and lift objects. Movements are typically repetitive and place strain on the affected
area. During this intervention, the client will be taught proper positioning and joint protection
techniques to reduce symptoms and avoid repeat episodes or injury. Emphasis will be placed in
avoiding wrist deviation, especially in conjunction with pinching (Trombly, 2008). The wrist
should be placed in a neutral position when completing tasks in this intervention. The
practitioner will encourage the client to take rest breaks when necessary, as well (Reed, 2014).
Approach. Once again, modification is the approach utilized in guiding the intervention.
Outcome. Education provided to the client on proper positioning aims to prevent recurrence of
injury.

Precautions/Contraindications
Precautions and contraindications should be adhered to while treating a client with de
Quervains tenosynovitis. Conservative approach in not indicated for persons with severe pain
(>8/10 on the patient pain analog scale), with inflammation along the radial sensory nerve, or

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with severe swelling of the dorsal first extensor compartment of the wrist (Reeds, 2014, p. 446).
When engaging a client in therapeutic exercise, exercise should not be encouraged beyond the
level of pain (Reeds, 2014). Severe swelling of the dorsal first extensor compartment of the wrist
calls for contacting the referring physician. If symptoms continue to worsen or do not respond to
conservative treatment despite compliance to the treatment plan, the referring physician should
be contacted as well. (OBrien, 2007).
Frequency and Duration
Frequency of hand therapy for the conservative management of de Quervains
tenosynovitis is typically one to two times a week, for six weeks, or as indicated by the clients
status and prognosis. Rachel is expected to meet her clinical goals within two weeks. Rachels
therapist reported her prognosis to be fair and expects to discharge her from therapy within two
weeks. An iontophoresis patch with dexamethasone was applied on her a couple of times. If
Rachel experiences relief from the iontophoresis patch, then conservative therapy may be worth
trying for a few sessions. Once the goals outlined are achieved, no further skilled care is
necessary and Rachel will be discharged.
Theoretical Framework
Rachels treatments were implemented utilizing the Canadian Model of Occupational
Performance and the Rehabilitation frame of reference (FOR). The Canadian Model of
Occupational Performance takes a holistic, client centered approach by considering the
interaction of the person, occupation and environment. Spirituality is at the core of the model,
resides within person, and gives meaning to occupations (Cole & Tufano, 2008). The model
provides a framework for enabling occupations that are meaningful to Rachel within her specific

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environment. The Rehabilitation FOR takes a top down approach and focuses on training with
the use of equipment or techniques (compensatory strategies) to facilitate independence when
remediation is not appropriate. Adapting task demands, utilizing adaptive equipment and use of
orthotics are adaptations incorporated to replace normal function or compensate for abnormal
function (Rybski, 2011). Combining these two theories, practitioners can offer adaptations to
improve occupational engagement in daily routines.
Client Education
Rachel will be educated on her diagnosis, prognosis and plan of care. It is vital for Rachel
to be knowledgeable of precautions and contraindications while receiving skilled rehabilitation
services to ensure termination of conservative treatment if her symptoms continue to worsen.
Education is an integral component in Rachels intervention plan. Rachel will be educated on the
pathology of her condition and the pros and cons of attending therapy, as well as various joint
protection techniques and orthosis options. Lastly, Rachel will be provided with a written home
program for thumb and wrist range of motion to prevent contractures. Wrist strengthening
activities will be incorporated in the home exercise program as well.
Rachel will be educated on modalities she can incorporate when experiencing pain. This
includes keeping her wrist in a neutral position, bracing, icing with elevation and pain-free range
of motion exercises and self-administered soft tissue-therapy (Howell, 2012). Utilization of
therapeutic change agents will help Rachel maximize pain relief independently, in the privacy of
her own home.
Monitoring of Response

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Throughout treatment, the client will be re-evaluated by skilled observations, self-reports

and final test. Observations will provide the therapist with information on the clients ability to
comply with intervention plans such as utilization of modified techniques demonstrated during
treatment session. If the clients performance is unsuccessful, the therapist will provide further
instruction or hand over hand assistance to ensure the client is properly positioning the wrist
while engaging in tasks. The Visual Analog Scale (VAS) is a self-report scale that helps clients
rate their pain on a scale of zero to ten (0 = no pain, 10 = pain), specify location of the pain, and
identify activities that increase or decrease pain levels (OBrien, 2007). The client will be
encouraged to voice any pain experienced during interventions using numbers on this scale so
appropriate modifications can be made. Lastly, the therapist will re-evaluate the clients right
wrist using the Finkelsteins test to determine if conservative treatments have been effective or if
symptoms continue to reveal diagnosis of de Quervains tenosynovitis. In cases were
conservative management are not effective or pain is reported by the client to be excruciating,
the client should be referred to their physician to discuss possibilities of surgical intervention
(OBrien, 2007).

References
American Occupational Therapy Association (2014). Occupational therapy practice framework:
Domain and Process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1),
S1-S48. http://dx.doi.org/10.5014/ajot.2014.682006

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Cole, M.B. & Tufano, R. (2008). Applied theories in occupational therapy. Thorofare, NJ:
Slack Incorporated.
Deshales, L. D. (2014). Upper Extremity Orthoses. In M. V. Radomski & C. A. Trombly Latham
(Eds.), Occupational therapy for physical dysfunction (7th ed., 429-471). Baltimore, MD:
Lippincott, Williams & Wilkins
Goel, R., & Abzug, J. M. (2014). de Quervains tenosynovitis: a review of the rehabilitative
options. HAND, 1-5. DOI 10.1007/s11552-014-9649-3
Howell, E. R. (2012). Conservative care of De Quervains tenosynovitis/tendinopathy in a
warehouse worker and recreational cyclist: a case report. The Journal of the Canadian
Chiropractic Association, 56(2), 121.
OBrien, M. (2007). Standards of care: De Quervains syndrome: Nonoperative management.
Boston, MA: Brigham & Womens Hospital, Department of Rehabilitation Services,
Occupational Therapy. Retrieved from www.
Brighamandwomens.org/Rehabiliationservices/OccupationalTherapyStandardsof
care.aspx?sub=1
Papa, J. A. (2012). Conservative management of De Quervains stenosing tenosynovitis: a case
report. The Journal of the Canadian Chiropractic Association, 56(2), 112.
Porter, R. S. (Ed.). (2011). The Merck manual of diagnosis and therapy (19th ed.). Whitman
Station, NJ: Merck Sharp & Dohme.
Reed, K. (2014). Quick reference to occupational therapy (3rd ed.). Austin, Texas: Pro-Ed.
Rybski, M. (2011). Kinesiology for occupational performance. Thorofare, NJ: Slack