de Quervain’s Tenosynovitis

Overview

What is de Quervain’s tenosynovitis?

De Quervain’s tenosynovitis occurs when the 2 tendons around the base of your thumb become swollen. The swelling causes the sheaths (casings) covering the tendons to become inflamed. This puts pressure on nearby nerves, causing pain and numbness.

Symptoms

What are the symptoms of de Quervain’s tenosynovitis?

The main symptom of de Quervain’s tenosynovitis is pain or tenderness at the base of your thumb. You might also feel pain going up your forearm. The pain may come on suddenly or develop slowly. It may get worse when you use your hand and thumb.

Other symptoms of de Quervain’s tenosynovitis include the following:

  • Swelling near the base of your thumb

  • A fluid-filled cyst in the affected area, which may or may not bulge through your skin

  • Numbness along the back of your thumb and index finger

  • A "catching" or "snapping" feeling when you move your thumb

  • A squeaking sound as the tendons move within the swollen sheaths

Causes & Risk Factors

Who is at risk of de Quervain’s tenosynovitis?

You are much more likely to develop de Quervain’s tenosynovitis if you are a woman, especially if you are 40 years of age or older. You are also more likely to develop it if one of the following is true:

  • Your hobby or job involves repetitive hand and wrist motions. This is a very common cause of the de Quervain’s tenosynovitis.

  • You have injured your wrist. Scar tissue can restrict the movement of your tendons.

  • You are pregnant. The hormonal changes that occur during pregnancy can cause de Quervain’s tenosynovitis.

  • You have arthritis.

Diagnosis & Tests

How is de Quervain’s tenosynovitis diagnosed?

To diagnose de Quervain’s tenosynovitis, your doctor may do a simple test called the Finkelstein test. First, you bend your thumb so it rests across your palm. Then you make a fist, closing your fingers over your thumb. Last, you bend your wrist toward your little finger. If you have tenderness or pain at the base of your thumb, you probably have de Quervain’s tenosynovitis.

Treatment

How is de Quervain’s tenosynovitis treated?

Treatment for de Quervain’s tenosynovitis focuses on reducing pain and swelling. It includes the following:

Your doctor may recommend injections of steroids or a local anesthetic (numbing medicine) into the tendon sheath to help reduce swelling and pain.

A physical therapist or occupational therapist can show you how to reduce stress on your wrist by changing how you move. He or she can also teach you exercises to strengthen your muscles. Most people notice improvement in 4 to 6 weeks and are able to use their hands and wrists without pain once the swelling is gone.

It is important to treat de Quervain’s tenosynovitis. If this condition isn’t treated, it can permanently limit your movement or cause the tendon sheath to burst.

  • Using a splint 24 hours a day for 4 to 6 weeks to rest your thumb and wrist.

  • Applying heat or ice to the affected area.

  • Taking a nonsteroidal anti-inflammatory drug (also called NSAIDs), such as ibuprofen (two brand names: Advil, Motrin) or naproxen (one brand name: Aleve).

  • Avoiding activities that cause pain and swelling, especially those that involve repetitive hand and wrist motions.

Will I need surgery for de Quervain’s tenosynovitis?

You might need surgery if your case is severe or if other treatments don’t relieve your pain. During outpatient surgery, the surgeon makes a small cut in the sheath around the swollen tendons. This provides more room for the tendons to move.

After surgery, you will need to do physical therapy to strengthen your wrist and thumb, and to prevent the problem from coming back. Once the area has healed and returned to full strength, you should have normal use of your hand.

Prevention

How can I prevent de Quervain’s tenosynovitis?

Avoiding repetitive movements is the most important way to prevent de Quervain’s tenosynovitis. Change your actions to reduce the stress on your wrists, and take frequent breaks to rest. Wear a brace or splint on your thumb and wrist, if necessary.

Follow the exercise routine suggested by your doctor or physical therapist. Be sure to tell him or her about any activities that cause pain, numbness or swelling.

Questions to Ask Your Doctor

  • What is the likely cause of my pain?

  • What is the best treatment option for me?

  • How long before I can expect relief from my symptoms?

  • When can I return to my activity (job, sport, etc.)?

  • Is it possible that my symptoms could return?

  • What kind of exercises should I do to strengthen my thumb?