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A Patient With De Quervain's Tenosynovitis: A Case Report Using an Australian Approach to Manual Therapy

M Anderson, PT, is Private Practitioner, Marin Orthopedic Rehabilitation, Mill Valley, CA 94941, and Senior Faculty Member, Kaiser Permanente-Hayward, Physical Therapy Residency Program in Advanced Orthopedic Manual Therapy, 27400 Hesperian Blvd, Hayward, CA 94545.
CJ Tichenor, PT, is Director, Kaiser Permanente-Hayward, Physical Therapy Residency Program in Advanced Orthopedic Manual Therapy, 27400 Hesperian Blvd, Hayward, CA 94545 (USA).

This case report describes a 41-year-old female patient who had chronic de Quervain's tenosynovitis, which had progressed to include involvement of the cervical spine, shoulder girdle, and upper extremity. The patient complained of aching over the left scapula, a band of pain around the upper arm, and sharp shooting pain in the forearm, with numbness and tingling in the fingers. On examination, she had abnormal palpatory findings in the cervical spine, the shoulder quadrant maneuver was limited, and the upper-limb tension tests (neural structures) were positive. The case report demonstrates the use of an Australian approach to manual therapy as described by Maitland. This approach includes (1) development, refinement, and rejection of working hypotheses as to the possible cause(s) of a patient's symptoms; (2) development of a long-range treatment plan; and (3) use of data from treatment responses to guide further treatment selection.

Key Words: De Quervain's tenosynovitis • Maitland • Manual therapy • Mobilization • Neural tension

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