Overview

What is de Quervain's tenosynovitis?

De Quervain's tenosynovitis is the term used to describe swelling of the tendons passing along the thumb side of the wrist and attaching at the base of the thumb. It comes when these tendons are constricted by the sheath through which they run to extend from the wrist to the hand.

What are the symptoms and signs of de Quervain's tenosynovitis?

The most common symptom of de Quervain's tenosynovitis is pain in your wrist on the same side as your thumb on the radial side. Others suddenly, or all at once, become aware of this pain, but some may develop it over time. Pain is usually:

• More severe with using your hand, wrist, and thumb.
• Radiates from your wrist into your thumb or forearm.
• Worst when you are gripping or pinching.

Other symptoms include:

• Swelling.
• Snapping or popping feeling at the bottom of your thumb, when you move your thumb in your wrist.
• Stiffness, less smooth feel of your thumb.
• Numbness of the wrist or thumb.

What causes de Quervain's tenosynovitis?

Anything that worsens irritation of your tendons in the thumb may cause de Quervain's tenosynovitis. Causes include:

• Repeating actions of your thumb or wrist
• This is performing repeated motions such as gripping something.
• Medical conditions that result in inflammation; for example, arthritis
• Direct hitting of your wrist or thumb

Things, in which your repetition of movement is involved, where you are holding on to something tightly, may lead to de Quervain's tenosynovitis, and among these activities is the following:

• Tennis, racquet ball, and skiing.
• Use of hammer or other tools.
• Carrying children around.
• Gardening.

What are the risks of de Quervain's tenosynovitis?

All people can get de Quervain's tenosynovitis, though some categories are predisposed to developing the disease:

• Women and females.
• Age over 40.
• Childcare providers.
• Parents of small children.
• Working individuals who handwork.
• Athletes.

How is de Quervain's tenosynovitis diagnosed?

A doctor can diagnose de Quervain's tenosynovitis with a physical examination. He or she will check your thumb and wrist. Discuss when you first noticed pain near your wrist and if any activities worsen it.

Which tests does the provider use to diagnose de Quervain's tenosynovitis?

Diagnosing de Quervain's tenosynovitis typically will employ the use of the Finkelstein test by healthcare providers. Your provider will have you make a fist with your fingers wrapped over your thumb. Then, holding that fist shape, you'll move your wrist up and down, as if you were shaking someone's hand. This is what isolates your thumb tendons. When you have de Quervain's tenosynovitis, it tends to be painful when moving your wrist in the Finkelstein test.

The doctor can also perform imaging tests, such as X-rays, to check for other conditions that may cause wrist pain, such as osteoarthritis, which affects the joints of the wrist.

How is de Quervain's tenosynovitis treated?

A healthcare provider will often recommend treatments for de Quervain's tenosynovitis to help manage your symptoms as your thumb tendons and their sheaths heal. Most common treatments include the following:

• Wearing a splint or brace: This will keep your wrist and thumb in place (immobilized) to take pressure off your thumb tendons.
• Applying ice to your wrist: Applying ice to the affected area will reduce swelling and ease pain. Wrap some ice packs in a thin towel and apply them to the wrist for 20 minutes, done several times daily.
• Rest: Do your best to avoid using your affected wrist. Try to avoid playing sports or performing repetitive motions, especially the motion that caused your de Quervain's tenosynovitis.
• NSAIDs: Available in any drug store in the form of over-the-counter medication, NSAIDs reduce the discomfort of pain and inflammation. Avoid using NSAIDs for more than 10 consecutive days without consulting with your provider.
• Corticosteroids: These are prescription medications that are anti-inflammatory agents. A corticosteroid injection may be administered to the affected tendon sheath by your provider.

De Quervain's tenosynovitis exercises

Your healthcare provider will suggest a course of exercises to enhance your wrist strength and flexibility. The simplest exercise is to grasp a tennis ball.

• Grip a tennis ball very lightly for 5 minutes.
• Relax for 5 minutes.
• If you didn't feel pain, grip more tightly.

Your doctor will tell you how often (and for how long) to stretch or exercise your wrist. Do not exercise through pain. If any stretch or exercise hurts, stop and call your provider.

De Quervain's tenosynovitis surgery

Most people do not need surgery to treat de Quervain's tenosynovitis; however, the doctor may advise surgery if other treatments have not helped improve the signs and symptoms.

De Quervain's tenosynovitis surgery is generally carried out as an outpatient procedure. In most instances, you will be discharged on the same day that your surgery is performed. A surgeon will make a tiny opening in your sheath overlying your tendons for your thumb. That gives more space to your tendons. If surgery is required, your surgeon will be able to give you an idea of what to expect specifically, including times of recovery.

Can de Quervain's tenosynovitis be prevented?

Prevention of tenosynovitis of the de Quervain's can best be achieved by avoiding overuse of your thumbs and wrists:

• Learn the right techniques and wear proper protective gear in sports, work, and other physical activities.
• Gradually intensify new exercises or activities as you get used to them so that you will not be injured
• Take breaks in repetitions
• If your wrist hurts during or after physical activity, do not play through the pain.

When should I see my doctor?

As soon as you start noticing any pain or other symptoms of de Quervain's tenosynovitis, visit a doctor. Do not ignore the symptoms, especially when they worsen with or after exercise.

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