Description

• Non inflammatory thickening of the tendons of the abductor pollicis longus and extensor pollicis brevis due to myxoid degeneration
• Characterised by pain and swelling over the radial styloid process
• Patients often complaints of pain near the base of thumb with an associated swelling
• It is common in women of age 30-50 years & those with occupation involving repetitive movements of the wrist

Types

• Swelling near the base of thumb
• Numbness along the back of thumb and index finger
• Pain with or without swelling of the radial styloid
• Catching/snapping feel on moving thumb
• Pain typically increases with gripping or rotating the wrist
• O/E - Tenderness over radial styloid and fusiform swelling
• The syndrome commonly occurs during and after pregnancy

Differential diagnosis

• Osteoarthritis of the first carpo-metacarpal joint
• Intersection syndrome—pain will be more towards the middle of the back of the forearm and about 2–3 inches below the wrist
• Wartenberg's syndrome – pain over the distal radial forearm associated with parasthesia

Investigation

• H/o injury or overuse
• Finkelstein test- Examiner grasps the affected thumb and exerts longitudinal traction across the palm of the hand towards the ulnar side, which causes pain
• CBC, CRP, ESR – in infectious synovitis
• X Ray – Assessment of possible bone involvement

Treatments

• Anti inflammatory
• Immobilization of thumb and wrist
• Apply ice to affected area
• Corticosteroid injection
• Splinting with thumb Spica brace
• Surgery - if non surgical treatment has failed and with persistent inflammation

Ayurvedic Treatment

Internal medicines

• Amrutothara Kashaya
• Guggulutikthaka Kashaya
• Punarnavadi Kashaya
• Balarishta
• Lakshadi guggulu
• Simhanada guggulu
• Gandha taila
• Aswagandha choorna + milk

Procedures

• Upanaha
• Patra potala Sweda/ Jambeera Pinda Sweda
• Agnikarma with Salaka /Madhu /Gudam
• Chronic cases- Taila Seka with Kottamchukkadi Taila/ Karpooradi Taila/ Ksheerabala Taila

Department

Salya Tantra