Physiotherapy by Dr. Nimra

08/12/2025

De Quervain's tenosynovitis

Here is a clear, concise overview of De Quervain’s Tenosynovitis:

De Quervain’s Tenosynovitis (Overview)
It is an inflammation of the tendons on the thumb side of the wrist, specifically the Abductor Pollicis Longus (APL) and Extensor Pollicis Brevis (EPB) tendons within the first dorsal compartment.

Causes
Repetitive thumb or wrist movements

Lifting heavy objects with thumb extended

Holding babies (“mother’s thumb”)

Overuse (texting, typing, gripping)

Trauma or direct injury

Inflammatory conditions (rarely)

Symptoms
Pain on the thumb side of the wrist

Pain worsens with gripping, lifting, twisting

Swelling near the radial styloid

Difficulty moving thumb

A catching or snapping sensation

Tenderness on the radial wrist

Special Test
Finkelstein Test
Patient makes a fist with thumb inside the fingers

Therapist ulnar deviates the wrist

Sharp pain over the radial styloid = positive

Physiotherapy Treatment
1. Acute Phase
Rest and activity modification

Thumb-spica splint

Ice 10–15 minutes

NSAIDs (if advised by doctor)

2. Manual Therapy
Soft tissue mobilization over APL & EPB

Myofascial release

Joint mobilization of wrist and thumb

3. Exercises
Stretching
Wrist ulnar deviation stretch

Thumb flexion stretch

APL/EPB tendon gliding

Strengthening
Isometric thumb extension

Wrist radial/ulnar deviation strengthening

Grip strengthening (light)

4. Modalities
Ultrasound therapy

TENS for pain relief

Laser therapy (if available)

5. Ergonomics
Avoid repetitive thumb strain

Modify lifting techniques

Use a supportive splint during activities

When to See a Doctor
If pain persists >2–4 weeks

Severe swelling

Suspected tendon rupture

Failure to improve with physiotherapy

May require corticosteroid injection or, rarely, surgery

08/12/2025

Overview of Golfer’s Elbow (Medial Epicondylitis):

Golfer’s Elbow:
Golfer’s elbow is pain and inflammation of the tendons on the inner side of the elbow. It happens due to overuse of the wrist flexor muscles.

Causes
Repetitive wrist flexion (bending wrist forward)

Gripping too hard

Sports: golf, baseball, bowling, tennis (topspin)

Occupations: carpenters, plumbers, typists

Poor technique in sports

Sudden increase in training load

Symptoms
Pain on inner side of the elbow

Pain increases with gripping or wrist flexion

Tenderness over medial epicondyle

Weak grip strength

Stiffness in the elbow

Pain radiating down forearm

Diagnosis / Special Tests
1. Medial Epicondylitis Test
Resist wrist flexion while elbow is extended → pain at medial epicondyle.

2. Golfer’s Elbow Test
Passive wrist extension stretches flexor tendons → pain at medial epicondyle.

Physiotherapy Treatment
1. Pain Relief Phase
Rest from aggravating activities

Ice for 10–15 minutes

Brace or counterforce strap

Ultrasound / TENS (optional)

2. Stretching
Wrist flexor stretch:
Extend elbow → pull wrist back into extension → hold 20–30 sec × 3–5 reps.

3. Strengthening
Start when pain reduces:

a) Isometrics:

Resist wrist flexion without movement.

b) Eccentric strengthening:

Slowly lower wrist from flexion to extension while holding a weight.

c) Grip strengthening:

Soft ball squeeze

Theraputty exercises

4. Manual Therapy
Soft tissue release of forearm flexors

Cross-friction massage at medial epicondyle

5. Functional Training
Correct technique in golf / racquet sports

Gradual return to activity

Prevention
Warm-up and stretching

Strengthen wrist flexors/extensors

Avoid overuse

Maintain good technique

Use proper equipment (correct grip size)

13/11/2025

Tennis elbow

13/11/2025

How to perform exercises at home for tennis elbow

Today's video covers three exercises you can do at home to help get rid of tennis elbow. Tennis elbow or lateral epicondylitis is a tendon issue (i.e. tendin...

12/11/2025

Tennis Elbow (Lateral Epicondylitis)

🔹 Definition:
Tennis elbow is a painful condition that occurs due to inflammation or degeneration of the tendons that attach to the lateral epicondyle (outer part of the elbow). It is usually caused by overuse of wrist extensor muscles, especially the extensor carpi radialis brevis.

🔹 Causes:
Repetitive wrist extension or gripping (e.g., playing tennis, typing, painting)

Overuse of forearm muscles

Poor technique in sports or work activities

🔹 Symptoms:
Pain and tenderness over the outer elbow (lateral epicondyle)

Pain worsens with gripping, lifting, or twisting motions

Weak grip strength

Sometimes pain radiates down the forearm

🔹 Diagnosis:
Physical examination:

Tenderness at lateral epicondyle

Cozen’s test: pain when wrist extended against resistance

Mill’s test: pain with passive wrist flexion and elbow extension

Imaging (ultrasound or MRI) may be used to rule out other causes

🔹 Physiotherapy Treatment:
Rest and activity modification

Ice therapy – 10–15 minutes, 2–3 times/day

Stretching and strengthening:

Wrist extensor stretch

Eccentric exercises for wrist extensors

Manual therapy:

Deep transverse friction massage

Mobilization with movement (Mulligan technique)

Ultrasound therapy / TENS

Bracing: counterforce elbow strap

Ergonomic advice: correct posture and wrist alignment

Gradual return to activity/sport

🔹 Prevention:
Warm up before activity

Strengthen forearm muscles

Use proper technique and ergonomic tools

Avoid repetitive strain