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Home » De Quervain's Tenosynovitis

De Quervain's Tenosynovitis

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Man holding a painful wrist

De quervain’s tenosynovitis is an injury that is associated with swelling of the two tendons at the base of your thumb. As a result of this swelling, the tendon sheath becomes inflamed and starts to press on nearby nerves in the hand.. The result is difficulty moving your thumb and wrist as well as pain and numbness on the thumb side of the wrist. Another name for this condition is De quervain’s syndrome. Yet another is de Quervain’s tendinosis.

Doctors are unclear as to the cause of De Quervain’s tenosynovitis. However, researchers have detected an apparent connect between the appearance of this injury and extensive performance of activities that require repetitive hand or wrist movements. We will detail the symptoms of this condition below, describe the main treatments and make some suggestions as to how you may be able to reduce the risk of its recurrence.

Causes & Risk Factors

Causes

As we have explained above, there is no known direct cause of this condition. However, it appears most often in individuals who have overused the wrist in repetitive movements. Examples of such activities include lifting a child into a car seat and lifting heavy grocery bags by the handles.

Other cases of de Quervain’s tenosynovitis appear to be linked to having a recent wrist injury that has caused scarring, or to a history of rheumatoid arthritis in the hands.

Risk Factors

The following factors appear to increase your risk of falling victim to de Quervain’s tenosynovitis:

  • Gender – it is more prevalent in women than in men;
  • Age – it has its highest prevalence between the ages of 30 and 50, and especially between 40 and 50;
  • Having a hobby or occupation that involves repetitive wrist movements;
  • Pregnancy and the hormonal changes it causes;

Symptoms Of De Quervain’s Tenosynovitis

As we have mentioned above, the main symptoms of De Quervain’s tenderness,  pain and swelling at the base of the thumb. Other signs and symptoms include:

  • Loss of feeling along the back of the thumb as well as the index finger;
  • A feeling that your thumb is sticking or “snapping” when you try to move it;
  • A squeaky sound in some cases, when you attempt to move your thumb. This sound is caused by the tight fit of the tendons running through the sheaths at the base of your thumb and controlling its movement.

If you have any of these symptoms, you should consider making an appointment with your doctor for a medical examination and diagnosis.

Diagnosis & Treatment

Diagnosis

To perform a diagnosis, your doctor will ask you questions about the location of your pain. He or she may also ask about any repetitive movements that you perform as part of a hobby, sporting pursuit or occupational responsibilities.

In most cases, your doctor will also perform a test known as the Finkelstein test. To do so, he will ask you to:

  • Rest your thumb across the face of your palm; then
  • Make a fist so that you close the other 4 fingers over your thumb; then
  • Bend your wrist in the direction of your little finger.

If following these directions produces pain or tenderness at the base of your thumb, you are probably suffering from de Quervain’s tenosynovitis.

In most cases, your doctor will not need to request an X-Ray or other imaging scan.

Treatment Of De Quervain’s Tenosynovitis

As an initial treatment of your de Quervain’s syndrome, your doctor may recommend the following conservative treatments:

  • Temporarily avoiding activities that require repetitive hand or wrist movements, as these may cause additional  stress to the thumb tendons and increase your pain and swelling;
  • Applying ice or a cold compress to the thumb side of your hand – probably for periods of about 20-30 minutes at a time, and at intervals of 2-3 hours. This will help to reduce the pain and inflammation you are feeling;
  • For additional control of pain and swelling , taking an anti inflammatory medication such as Advil;
  • Wearing a thumb spica splint or brace that will help to immobilize your thumb. By doing this, the splint will reduce the movement of the thumb tendons through their sheath and allow them to recover naturally;
  • Injections of corticosteroids into the tendon sheath to reduce inflammation. Corticosteroid injections for de quervain’s are in widespread use to treat the condition and are generally successful.

Surgery

If a conservative treatment approach does not produce improvement, your doctor may recommend surgery. This is usually an outpatient procedure and involves making a small cut in the tendon sheath. The hope is that this will increase room for the tendons to move and reduce their irritation. This will in turn reduce your pain and swelling from de Quervain’s tenosynovitis.

Physical & Occupational Therapy

An important part of either the conservative or surgical treatments will be having you work with a physical therapist. The therapist can devise an exercise program to strengthen the muscles of your hand and thumb. Stronger wrists and thumbs will be more able to withstand the repetitive movements that may have caused your de Quervain’s tenosynovitis in the first place.

Your doctor may also refer you to an occupational therapist. He or she will interview you about the daily tasks you perform that may have contributed to your de Quervain’s syndrome. You will then be given suggestions about changes to your equipment or techniques that will reduce the stress on your wrist and thumb and help you to avoid this condition in the future.

Prevention Of De Quervain’s  Tenosynovitis

A natural question to ask is whether there is anything that you can do to avoid the recurrence of this painful condition. While complete avoidance may not be possible, you can reduce your risk of recurrence by:

  • Avoiding repetitive hand or wrist movements as much as possible;
  • If you do have to perform such activities, taking frequent small breaks to allow your hands to rest;
  • Trying to introduce frequent small changes to things like the positions of your hands while you perform these activities.

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