About De Quervain’s tenosynovitis

In de Quervain’s tenosynovitis, the sheath of the tendons on the thumb side of your wrist becomes inflamed or swollen, restricting the tendons’ movement. The result with de Quervain’s tenosynovitis is discomfort and pain every time you turn your wrist, grasp anything or make a fist.

Treatment for de Quervain’s tenosynovitis may range from immobilizing your wrist and taking medications to surgery in more serious cases. If you start treatment early on, your symptoms of de Quervain’s tenosynovitis should generally improve within four to six weeks.

Symptoms

The main signs and symptoms of de Quervain’s tenosynovitis are pain and swelling near the base of your thumb. The pain may appear suddenly or may increase over time. If the condition goes too long without treatment, the pain may spread farther into your thumb, back into your forearm or both. Pinching, grasping and other movements of your thumb and wrist aggravate the pain.

Symptoms of de Quervain’s tenosynovitis include:

  • Pain near the base of your thumb
  • Swelling near the base of your thumb
  • Numbness in the back of your thumb and index finger, caused by the swollen tendon rubbing on a nerve
  • A fluid-filled cyst in the same region as the swelling and pain
  • Difficulty moving your thumb and wrist when you’re doing activities that involve grasping or pinching
  • A “sticking” or “stop-and-go” sensation in your thumb when trying to move it
  • A squeaking sound as the tendons try to move back and forth through the inflamed sheaths

Causes

When you grip, grasp, clench, pinch or wring anything in your hand, you use two major tendons in your wrist and lower thumb. These tendons run side by side from your forearm through the thumb side of your wrist. They normally glide unhampered through the small tunnel that connects them to the base of the thumb. In de Quervain’s tenosynovitis, the tendons’ slippery covering becomes inflamed, restricting movement of the tendons.

A common cause is chronic overuse of your wrist. For example, peeling carrots involves a repetitive motion, a bent wrist and the gripping of the peeler. If you peel carrots or potatoes day after day, hour after hour, this combination may be enough to irritate the sheath around the two tendons.

Other causes of de Quervain’s tenosynovitis include:

  • Direct injury to your wrist or tendon; scar tissue can restrict movement of the tendons
  • Inflammatory arthritis, such as rheumatoid arthritis

People most at risk of de Quervain’s tenosynovitis tend to be those whose occupations or hobbies involve repetitive hand and wrist motions, such as carpenters, office workers and musicians. Even the awkward hand and wrist positions that new parents use in holding and rocking their children may cause the condition. De Quervain’s tenosynovitis occurs most often in middle-aged women.

Consult your doctor if you’re still having problems with pain or function and you’ve already tried:

  • Avoiding repetitive thumb movements whenever possible
  • Avoiding pinching with your thumb when moving your wrist from side to side
  • Applying heat to the affected area
  • Using nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve)

If the pain continues to interfere in your daily life or activities, seek medical advice.

Diagnosis

Your doctor may confirm a diagnosis of de Quervain’s tenosynovitis by doing a Finkelstein test. In this simple test, you bend your thumb across the palm of your hand and bend your fingers down over your thumb. Then you bend your wrist toward your little finger. If this causes pain on the thumb side of your wrist, the test is considered positive.

If you feel pain about three inches up your forearm, you may have a condition called intersection syndrome. This is similar to de Quervain’s tenosynovitis, but affects a different area of your wrist and requires different treatment.

Treatment

To reduce pain and swelling, initial treatment of de Quervain’s tenosynovitis may include:

  • Immobilizing your thumb and wrist, keeping them straight with a splint or brace to help rest your tendons
  • Avoiding repetitive thumb movements whenever possible
  • Avoiding pinching with your thumb when moving your wrist from side to side
  • Applying heat to or icing the affected area
  • Using nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve)

Your doctor may also recommend injections of corticosteroid medications into the tendon sheath to reduce swelling.

Treatment is generally successful if begun early on, though overuse injuries often recur if you have difficulty discontinuing the repetitive motions that caused the condition in the first place.

Making adjustments
Your medical team may include a physical therapist or occupational therapist who may monitor your habits and give suggestions on how to make necessary adjustments to relieve stress on your wrists. Your therapist can also teach you exercises focused on your wrist, hand and arm to strengthen your muscles, reduce pain and limit the irritation of the tendons.

In more serious cases
If your case is more serious, your doctor may recommend outpatient surgery. Surgery involves a procedure in which your doctor inspects the sheath surrounding the involved tendon or tendons, and then opens the sheath to release pressure.

Self-care

If you don’t need surgery, caring for your condition is much the same as preventing it:

  • Avoid repetitive hand and wrist movements.
  • Wear a brace or splint if suggested by your doctor.
  • Follow through with recommended exercises.
  • Take special note of any activity that causes pain, swelling or numbness in your thumb and wrist, try to avoid it, and share that information with your doctor.

If you do need surgery, it may be several months before the tenderness in your wrist completely goes away. Your doctor will talk to you about how to rest, strengthen and rehabilitate your body after surgery. Your physical or occupational therapist will meet with you regularly to assess your progress, teach you new strengthening exercises, and help you adjust your daily routine to prevent a recurrence of the condition.

If possible, make a conscious effort to avoid repetitive wrist and hand movements and pinching with your thumb when moving your wrist from side to side. That may be enough to prevent de Quervain’s tenosynovitis. If you have a job that involves intensive use of your hands or wrists, try to make adjustments in your daily routines to reduce the stress on your wrists.