de Quervain’s Tenosynovitis

de Quervain’s Tenosynovitis

What is de Quervain’s tenosynovitis?

De Quervain’s tenosynovitis is a painful condition that affects the tendons in your wrist. It 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 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 develop slowly or come on suddenly. It may get worse when you use your hand, thumb, or wrist.

Other symptoms include:

  • Swelling near the base of your thumb.
  • 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.

What causes de Quervain’s tenosynovitis?

The most common cause of de Quervain’s tenosynovitis is chronic overuse of the wrist. Repetitive movements day after day cause irritation and pain. One common movement that causes it is lifting a child into a car seat. Another is lifting heavy grocery bags by the handles. Other causes could include a direct injury to the wrist or inflammatory arthritis.

You are more likely to develop de Quervain’s tenosynovitis if:

  • You are a woman.
  • You are 40 years of age or older.
  • Your hobby or job involves repetitive hand and wrist motions. This is a very common cause.
  • You have injured your wrist. Scar tissue can restrict the movement of your tendons.
  • You are pregnant. Hormonal changes during pregnancy can cause it.
  • You have arthritis.

How is de Quervain’s tenosynovitis diagnosed?

To diagnose de Quervain’s tenosynovitis, your doctor may do a simple test. It is 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.

Other tests such as X-rays usually aren’t needed to diagnose the condition.

Can de Quervain’s tenosynovitis be prevented or avoided?

The best way to prevent de Quervain’s tenosynovitis is to avoiding repetitive movements. Change your actions to reduce the stress on your wrists. Take frequent breaks to rest if you are using your wrists. 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.

De Quervain’s tenosynovitis treatment

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

  • Applying heat or ice to the affected area.
  • Taking a nonsteroidal anti-inflammatory drug (NSAID). These include ibuprofen (Advil, Motrin) or naproxen (Aleve).
  • Avoiding activities that cause pain and swelling. Especially avoid those that involve repetitive hand and wrist motions.
  • Wearing a splint 24 hours a day for 4 to 6 weeks to rest your thumb and wrist.
  • Getting injections of steroids or a local anesthetic (numbing medicine) into the tendon sheath. These injections are very effective and are used regularly.

A physical therapist or occupational therapist can show you how to change the way you move. This can reduce stress on your wrist. He or she can also teach you exercises to strengthen your muscles.

Most people notice improvement after 4 to 6 weeks of treatment. They are able to use their hands and wrists without pain once the swelling is gone.

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. This will help keep the problem from coming back. Once the area has healed and returned to full strength, you should have normal use of your hand.

Living with de Quervain’s tenosynovitis

De Quervain’s tenosynovitis is a temporary condition. It generally responds well to treatment. 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. Once your symptoms are better, work to prevent the condition from happening again.

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?