Occupational De Quervain’s Tenosynovitis in a Physiotherapy Intern: A Case Report of Repetitive Manual Therapy and Ergonomic Modification

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Abstract Background De Quervain’s tenosynovitis (DQT) is an overuse condition affecting the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons in the first dorsal compartment of the wrist. De Quervain’s tenosynovitis is commonly caused by repeated thumb and wrist movements. Physiotherapists performing soft tissue manual therapy such as myofascial release (MFR) and ultrasound treatment are at risk of developing this work-related musculoskeletal disorder. Objective To report a case of occupational De Quervain’s tenosynovitis in a physiotherapy intern and discuss the importance of early diagnosis, activity modification, and ergonomic correction. Case Description A 24-year-old right-hand dominant physiotherapy intern with a complaint of pain over the volar and dorsal aspect of the right thumb for the past four days was brought to the out-patient physiotherapy clinic. The patient was undergoing clinical internship where she was frequently involved in MFR of approximately 5 patients a day and ultrasound application. The pain was exacerbated by activities such as MFR, forceful grip, pinching, and lifting of the patient’s thumb. On examination, pain on palpation of the first dorsal compartment of the wrist, positive Finkelstein’s test, full range of motion (ROM) of the thumb with pain at end range, and thumb muscle strength of 4/5 due to pain were noted. The patient’s pain was severe with a Numeric Rating Scale (NRS) score of 9/10. Interventions The patient was managed with physiotherapy interventions for DQT such as patient education, activity modification, ergonomic correction, pulsed ultrasound, thumb taping, Grade I and II mobilization, cryotherapy, pain-free active ROM, and tendon glide exercises for the APL and EPB tendons. Isometric strengthening, grip and pinch exercises, and guidance on proper hand position during MFR were also performed. Outcome Measures The primary outcome measure was the reduction in pain intensity recorded using the Numeric Rating Scale (NRS). Secondary outcome measures included the improvement in thumb ROM, Manual Muscle Test (MMT), and Finkelstein’s test and the patient’s ability to perform routine clinical procedures. Results After two weeks of conservative physiotherapy management, the patient’s pain score reduced from 9/10 to 2/10 on the NRS. The patient’s thumb and wrist movements became pain-free, and her muscle strength improved from 4/5 to 5/5. Finkelstein’s test was negative, and the patient was able to resume her clinical internship with minimal discomfort. Conclusion The case highlights the occurrence of De Quervain’s tenosynovitis ( DQT )as an occupational overuse injury among physiotherapy interns. Early diagnosis, conservative physiotherapy management, activity modification, and ergonomic correction reduced pain and improved the patient’s functional ability, facilitating an early return to clinical practice while reducing the risk of recurrence.