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De Quervain’s tenosynovitis

De Quervain’s tenosynovitis (dih-kwer-VAINS ten-oh-sine-oh-VIE-tis) is a painful disorder affecting the tendons on the thumb side of your wrist. The tendons surrounding the base of the thumb become irritated or constricted. If you have de Quervain’s tenosynovitis, it will probably be most noticeable when making a fist, holding or gripping something, or when rotating the wrist.

Anatomy

Two of the main tendons to the thumb go through a tunnel called a sheath located on the thumb side of the wrist. The tendons connect muscle to bone and are enclosed by a slippery thin layer called synovium. This layer lets the tendons slide easily through the sheath.

Swelling of the tendons or thickening of the sheath produces increased friction and pain with particular wrist or thumb movements.

Causes

De Quervain’s tendinosis may be triggered by overuse. Although the exact cause of de Quervain’s tenosynovitis isn’t known, any activity that requires repetitive wrist or hand movement can cause it to become worse.

• New mothers who are lifting and carrying a baby frequently.
• Hormonal fluctuations related to pregnancy.
• More common in patients with inflammatory diseases such as diabetes and rheumatoid arthritis.
• Repetitive gripping activities with wrist flexion and extension such as gardening, playing golf, or racket sports.
• Performing a particular movement day after day could aggravate the sheath around the two tendons and produce thickening and swelling that impedes movement.
• An injury directly to the wrist or tendon.
• Scar tissue buildup can limit movement of the tendons.

Risk factors

Risk factors for de Quervain’s tenosynovitis include:

• Age – People between 30 – 50 have a higher risk of developing de Quervain’s tenosynovitis.
• Gender – Common in middle-aged women.
• Pregnancy – de Quervain’s tenosynovitis may be linked with pregnancy.
• Caring for an Infant – Lifting a child repeatedly involves using the thumbs as leverage and may also be associated with the condition.
• Repetitive hand and wrist movements – People who have jobs or hobbies that require repetitive hand and wrist motions frequently have a higher risk of developing de Quervain’s tenosynovitis.

Symptoms

The main symptom is pain felt at the base of the thumb and wrist. The pain may develop either slowly or suddenly. Pain is generally felt in the wrist when forcefully grasping objects or twisting the wrist and can move up the arm. Typically the pain is worse when the hand and thumb are in use.

• A fluid-filled cyst may accompany the swelling.
• On occasion, a sticking sensation may be felt as the thumb moves.
• Pain and swelling may make it hard to move the thumb and wrist.
• If the condition is left untreated for a period of time, the pain may move further into the patient’s thumb, forearm, or both. Continued movements of the thumb and wrist will usually produce more pain.

When to see a doctor

You should see a orthopedic hand specialist if you are having pain or function issues and you’ve already tried:

• Applied cold to the affected thumb and wrist.
• Immobilized the affected thumb.
• Utilized nonsteroidal anti-inflammatory drugs, such as Advil, Motrin IB, or Aleve.

Doctor Examination

Your physician may ask you to do the Finkelstein test to establish whether you have de Quervain’s tendinosis. First, place your thumb against your hand and make a fist with your fingers closed over the affected thumb. Next, he will ask you to bend your wrist toward your little finger.

If you do indeed have de Quervain’s tendinosis, the test will be very painful, triggering tendon pain on the thumb side of the wrist.

Complications

Left untreated, de Quervain’s tenosynovitis may make it difficult to use your hand and wrist correctly. It may also limit your range of motion for the affected wrist.

Treatments

Nonsurgical Treatment

• Splints may be utilized to rest the wrist and thumb.
• Anti-inflammatory medication (NSAIDs) can be taken orally or injected into a tendon compartment.
• Avoid activities that cause pain and swelling.
• Corticosteroid injections into the tendon sheath may reduce swelling and pain.

Surgical Treatment

Surgery may be recommended if symptoms are severe or do not improve with nonsurgical treatments. The objective of surgery is to widen the thumb compartment and to make more room for the irritated tendons.

Whichever treatment, normal use of the hand can usually be resumed once the hand is strong and pain-free. Your orthopedic hand surgeon can advise you on the best treatment for your situation.