Ayurveda Understanding of De Quervain’s Tenosynovitis

Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa S, B.A.M.S

De Quervain’s tenosynovitis is an inflammatory, painful condition which presents with swelling in the tendons around the thumb. It occurs when the tendons become constricted within their protective sheath. It is often caused due to repetitive thumb or wrist movements.

Thickening and degeneration of protective tendon sheath around the thumb tendons, repetitive thumb or wrist movements and sudden traumatic injury to the wrist or thumb are the main causes.

Predominant symptoms include pain and swelling in the thumb, tenderness, difficulty in moving the thumb, numbness and popping or snapping sensation in the wrist.

Related Reading – ‘De Quervain’s Tenosynovitis – causes, symptoms, prevention, treatment and Ayurveda Management’

Ayurveda Understanding of De Quervain’s Tenosynovitis

Vata aggravation

De Quervain’s Tenosynovitis is a painful condition. Pain cannot occur without the involvement of Vata. So, it qualifies to be called as a condition caused by aggravated vata in the region of the thumb.

Vata Vyadhi, Vatarakta and other conditions to be considered in comparative study

Hand and fingers or toes will be involved in the painful conditions caused by vata and or rakta. So, this condition can be considered as one of the below mentioned conditions occurring or limited only to the region of the hand around the thumb and may be involving the wrist joint –

–        Vata Vyadhi

–        Vatarakta

–        Amavata

–        Sandhigata Vata

–        Shotha

–        Kandaragata / Snayugata Vata

Tendon sheaths undergo degeneration in this condition. This is brought about by aggravated Vata. Fingers, toes and the joints of the limbs, including the small joints of hands and feet are also involved in amavata, sandhigata vata or vatarakta. The pathogenesis should be understood on the basis of the symptoms of dosha or doshas which are predominant in the clinical picture of the disease.

From the perspective of causes

From the perspective of causes also, it seems to be apt to include it under Vata Vyadhi or Vatarakta. This condition is caused due to repetitive use or movements occurring at the thumb joint or wrist joint or both. Vata and also rakta get aggravated by repetitive movements. This Vata may cause degeneration of tendons or tendon sheaths, weaken the muscles and joints therein and cause pain and other conditions. Swelling may be caused due to involvement of vata, rakta or kapha in different combinations. Inflammatory swelling around the thumb and the tendons therein may suggest involvement of pitta and or rakta. Non-inflammatory swelling or oedema which may occur in later stages of the diseases reflect the involvement of kapha too.

From the perspective of Symptoms

Symptoms also point towards involvement of Vata including pain, tenderness, swelling, difficulty in movements, numbness and popping sensation. Any dosha might get associated with vata in the long run.

Indriya and Marma involvement

Since De Quervain’s Tenosynovitis is a painful condition which afflicts the thumb and hand, it is clear from Ayurveda perspective that the karma indriya i.e. organ of action ‘pani’ is affected. When this indriya is affected, one would find it difficult to manage the activities which are meant to be done by the hands, including grasping.

More difficult would be the movements and actions happening at the hands if the marmas located therein are affected. Kshipra Marma is the closest one for the thumb. When this marma is injured, it is said that akshepa – convulsions in the upper limb and marana – death would ensue. Death may here be considered as death of functions and actions of the hand and upper limb. It is a Kalantara Pranahara Marma i.e. that causes death or destruction of activities gradually after being injured. De Quervain’s Tenosynovitis may be the effect of collective affliction or impact of injury of many Marmas in the vicinity of the thumb – Talahridaya, Kurcha, Kurchashira and Manibandha Marmas along with Kshipra Marma. When there is delayed healing or relief from symptoms or when there is progression of disease, worsening with time, in spite of timely interventions, should draw our attention towards the involvement of marmas of the hand.

Treatment principles

Nidana Parivarjana forms the most important principle in treating De Quervain’s Tenosynovitis. The person has to keep away from overusing the thumb and hand and avoid vata aggravating foods, behaviours and activities. Change in profession too can be considered if it is the cause or trigger for the problem.

Treatment of De Quervain’s Tenosynovitis mainly includes management of Vata and treating mainly on the lies of Vata Vyadhi and Vatarakta. The other conditions mentioned above too shall be considered if the clinical pictures of these conditions match with Tenosynovitis.

The treatment principles of the disease which exactly correlates with De Quervain’s Tenosynovitis shall be adopted. The physician can also take the liberty of planning the protocol of treatment after having properly understood the pathogenesis and components of pathogenesis of the disease from Ayurveda perspective. The principles shall be borrowed from different conditions mentioned above, as per Ayurveda and the treatment line designed.

If De Quervain’s Tenosynovitis is secondary to a main disease like Vatarakta or Vata Vyadhi, which most often is, it shall be treated on the lines of treating the main disease.

The mainstays of symptomatic management and also disease specific therapies would be –

External –

–        Abhyanga

–        Dhara

–        Lepa

–        Upanaha

Internal – Shodhana

–        Virechana

–        Vasti

If the pain and other symptoms are stubborn and not responding to conventional treatments, the involvement of Marmas in and around the thumb should be considered. They are –

–        Kshipra Marma

–        Manibandha Marma

–        Talahridaya, Kurcha and Kurchashira Marmas

Regular administration of Vasti and Rasayanas are important ingredients of the treatment in this context.

The rest of the understanding of the disease and its management should be on similar lines as explained in the below mentioned article.

Related Reading – ‘Extensor Tendonitis – Ayurveda Understanding’