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De Quervain’s Tenosynovitis

De Quervain’s Tenosynovitis, pronounced DEE-KUR-vains TEE-no-SIGH-no-VY-tis, is a condition that affects part of the hand, causing pain in tendons on the thumb side of the wrist. A patient who is suffering from De Quervain’s Tenosynovitis will most likely be experiencing pain whenever the wrist is turned; the hand is grasping anything or when a fist is made.

The exact cause of De Quervain’s Tenosynovitis is not known, but it has been found that activities that involve strain on the wrist or thumb side area of the hand causes stress to the joint and can worsen the symptoms.

Causes of De Quervain’s Tenosynovitis

Although a clear cause of De Quervain’s Tenosynovitis has not been determined, there is clear evidence pointing to the possibility of this condition being caused by chronic overuse and strain on the wrist.

Tendons are rope-like structures that attach muscle to bone. The two tendons in the lower part of the thumb and wrist are designed to glide through a small tunnel that connects them to the base of the thumb. This occurs whenever the hand is used to grip, pinch, wring, grasp or clench anything. Repetition of this, for whatever reason this may occur, can cause irritation and swelling on the sheath around these tendons, and in doing so, can stiffen and restrict these movements.

It is also possible that De Quervain’s Tenosynovitis could be caused by other issues with the hand or wrist, including rheumatoid arthritis or direct injury to the wrist or the tendon, which can cause restrictions through the growth of scar tissue.

Risk Factors for De Quervain’s Tenosynovitis

Risk factors for De Quervain’s Tenosynovitis include the following:

  • Age. Patients between the ages of 30 and 50 are more at risk of developing this condition than other age groups, particularly children
  • Sex. This condition is more prevalent in females than males
  • Pregnancy. Studies have shown a possible correlation between pregnancy and this condition, although the reason for this is not fully understood
  • Jobs, hobbies, and vocations that require repetitive hand and wrist motion and regular pressure or strain on the wrist

Symptoms of De Quervain’s Tenosynovitis

Symptoms of De Quervain’s Tenosynovitis are:

  • Pain at the base of the thumb
  • Swelling around the base of the thumb
  • Limitation in the movement of the thumb due to the swollen area around the tendons, making it difficult to grasp or pinch items
  • A sticking or locking of the thumb joints when trying to move it
  • Tenderness and swelling of the wrist just below the thumb

When left untreated for too long, the pain a patient experiences can spread further into the thumb, and can also extend lower down the forearm. The symptoms are almost always aggravated by the use of pinching or grasping movements.

Diagnosis of De Quervain’s Tenosynovitis

Home remedies can be used prior to a doctor’s visit or diagnosis. If the problems persist following the trial of any of the following, it is advised that the patient contact their doctor for a close examination and to explore further treatment options.

A doctor’s appointment should be set up if:

  • The thumb is no longer in use due to pain and stiffness
  • The patient has regularly applied a cold compress to the affected area and little to no change has occurred
  • The patient has used anti-inflammatory over the counter medications, such as ibuprofen and naproxen

Typically a diagnosis will be made based on the appearance of the thumb and or wrist in question. A doctor will also examine the tenderness and level of pain a patient is experiencing.

The doctor will apply pressure to the thumb side of the wrist to establish how much pain this causes the patient. A doctor will often also perform a Finkelstein test: a diagnostic procedure associated with this condition, in which a patient bends their thumb across the palm of the hand, then folds the fingers over the thumb (similar to making a fist), and then leans the wrist in the direction of the little finger. If there is a noticeable pain in the thumb side of the wrist, it is likely that the patient has De Quervain’s Tenosynovitis.

In the majority of cases, imaging tests such as X-rays are not needed for diagnosis.

Treatment of De Quervain’s Tenosynovitis

Like most conditions of a similar nature, the earlier a diagnosis is made and treatment can begin the faster the recovery time. Also, when this condition is spotted early, the necessary treatment is far less extensive and complicated than if ignored.

The main aim of treatment for De Quervain’s Tenosynovitis is to reduce swelling and pain, return to normal use of the thumb, and prevent recurrence.

A note for pregnant mothers suffering from this condition: If the condition began during pregnancy, it is likely to resolve itself after pregnancy or completion of breastfeeding.

Beyond suggestion of over the counter medications to reduce swelling, the doctor may suggest his patient receive corticosteroid injections the sheath covering the tendons, which will reduce swelling and irritation. If the treatment begins within the first 6 months of the condition’s occurrence, it is most likely that the patient will recover fully with just one injection.

Hand Physical Therapy

The doctor may suggest that the best way to treat a particular case is to use hand physical therapy instructions by one of hand therapist some or all of the following ways:

  • Immobilization of the thumb and wrist, preventing bending or strain on the tendons, giving them chance to recover naturally
  • Avoiding regular and repetitive use of the thumb
  • Avoiding the action of pinching using the thumb whilst the wrist moves from side to side
  • Applying ice to the affected area

Depending on the development of the condition, it may be advised that a patient seeks physical or occupational therapy. The therapists would observe a patients usage of the wrist in daily activities and advise on adjustments that could be made in an effort to relieve stress on the wrist. In addition, a therapist may teach a patient exercises on how to strengthen muscles in the wrist, hand, and arm to help relieve irritation and pain.

Surgery for De Quervain’s Tenosynovitis

If the condition is more severe; the above treatments have proved ineffective; or if a patient has had one or more recurrences of De Quervain’s Tenosynovitis, a doctor may well recommend surgery. The surgery is completed in outpatient care.

This procedure requires a doctor to inspect the sheath surrounding the tendons to check for swelling and then opening the sheath to release pressure and allow the tendons to glide as they did previously. This will relieve swelling, pain and motor restrictions in the wrist and thumb.

Rapid Diagnosis and Treatment Plan

If you are experiencing pain or limitation in movement in your wrist or thumb, it is possible that you may be experiencing the symptoms of De Quervain’s Tenosynovitis. Contact your doctor so that you can receive a correct and effective treatment for the early stages of this condition and avoid surgery.

Doctors Appointment

If you believe you may be suffering from De Quervain’s Tenosynovitis and would like a firm diagnosis, please contact your doctor to assess the progression of the disease and seek out the best treatment option for your case.

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