De Quervain’s tenosynovitis is an inflammation of the tendons in the wrist near the thumb. It affects the sheath (the synovium) which surrounds two particular tendons running between the wrist and the thumb that are responsible for making the thumb move.
The sheath may thicken and become swollen. When this happens, any movement of the thumb can become very painful, especially when trying to grasp or pinch something – and this is the main indicator of de Quervain’s tenosynovitis.
What Causes de Quervain’s Tenosynovitis?
Tendons are the thick tissues that attach our muscles to our bones, and they can become inflamed (swollen) and sore for different reasons. This inflammation is mainly due to overuse or from a sprain. When this happens to the tendons between the thumb and the wrist, de Quervain’s develops.
The exact cause of de Quervain’s is still unknown, because performing the same motions do not affect everyone in this manner. But overuse of the tendons, particularly repetitive movements used at work or while playing sports, can contribute to de Quervain’s and make the pain and inflammation worse.
Other causes can include:
· A direct strike or injury to the thumb
· Repetitive tasks such as in the workplace and gaming
· Activities such as gardening or racket sports (tennis, badminton, etc.)
· Inflammatory conditions such as rheumatoid arthritis
· Regularly carrying and lifting heavy items, such as grocery bags and putting children into car seats
Symptoms of de Quervain’s
Depending on the cause, symptoms of de Quervain’s can come on suddenly or may develop slowly. The main symptoms may include:
· Pain, tenderness, and swelling at the base of the thumb
· Pain running up the forearm
· Pain that is made worse by movements involving the thumb and the wrist, such as pinching or grasping
· Numbness along the thumb and index finger
· A snapping sensation (sometimes causing a sound) when moving the thumb, much like plucking a rubber band
Who Is at Risk of Developing This Condition?
Anyone can develop the condition, but you are more at risk if:
· You are a woman
· You are pregnant
· You have just had a baby
· You are age 40 or over
· You do a job, hobby, or play a sport that involves repetitive wrist and hand motions
· You have arthritis
· You have a wrist injury (internal scar tissue can restrict the movement of tendons)
How Is de Quervain’s Tenosynovitis Diagnosed?
The simplest way for your doctor to diagnose de Quervain’s is by performing Finkelstein’s test. This involves placing your thumb in the palm of your hand and making a fist around it. You then bend your wrist downward, toward your little finger.
If movement is limited, or if this motion makes the pain by the base of your thumb worse, the test is considered positive and you will likely be diagnosed with de Quervain’s.
How Can It Be Treated?
The severity of de Quervain’s will determine the best course of treatment, but it may include:
· Rest – This limits the movements that aggravate the condition, thereby helping to reduce pain and allowing the symptoms to settle.
· Anti-inflammatory medication and/or gels – This can help to reduce pain and swelling.
· Wearing a splint – This helps to limit the movement of your thumb and wrist and to rest the inflamed tendons.
· Cortisone injections – When injected into the tendon sheath, these can help to reduce swelling and pain.
· Physical or occupational therapy – A therapist can help to teach you strengthening and stretching exercises and ways to reduce the stress placed on the tendons.
Surgery is recommended when symptoms persist and do not improve with treatment. The surgery is typically an outpatient procedure.
In this operation, the wrist area will first be numbed. The surgeon will then make a small incision in your wrist and into the sheath that covers the tendon. This creates a larger space for the tendon to move more freely and to relieve compression.
The doctor may also remove the swollen tissue in the sheath. The incision is then closed. Most patients feel immediate relief and make a full recovery with good results.
Orthopedic Surgeons for Hands and Wrists
If you think you may be suffering from a condition in the wrist such as tenosynovitis or tendonitis, contact our team at Watauga Orthopaedics today to schedule a consultation. Our highly qualified, skilled, and compassionate orthopedists are here to diagnose and treat all types of hand and wrist injuries and conditions, including de Quervain’s tenosynovitis.
We are here to help you regain your full function so you can make a complete recovery and get back to the activities and lifestyle you enjoy. Call us at (423) 282-9011 to request an appointment, or schedule an appointment online. We look forward to serving you.