Overview
Although the exact cause of de Quervain tenosynovitis isn't known, any activity that relies on repetitive hand or wrist movement — such as working in the garden, playing golf or racket sports, or lifting a baby — can make it worse.
Symptoms
Symptoms of de Quervain tenosynovitis include:
1.Pain near the base of the thumb
2.Swelling near the base of the thumb
3.Difficulty moving the thumb and wrist when doing something that involves grasping or pinching
4.A "sticking" or "stop-and-go" sensation in the thumb when moving it
If the condition goes too long without treatment, the pain may spread farther into the thumb or forearm or both. Moving the thumb and wrist may make the pain worse.
When to see a doctor
Consult your health care provider if you're still having problems with pain or function and you've already tried:
1.Not using your affected thumb
2.Applying cold to the affected area
3.Using nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve)
Causes
De Quervain tenosynovitis affects the two tendons on the thumb side of the wrist. Tendons are ropelike structures that attach muscle to bone.
Chronic overuse, such as repeating a particular hand motion day after day, may irritate the covering around the tendons. If the covering becomes irritated, the tendons can thicken and swell. This thickening and swelling restrict the movement of the tendons through the small tunnel that connects them to the base of the thumb.
Other causes of de Quervain tenosynovitis include:
1.Inflammatory arthritis, such as rheumatoid arthritis.
2.Direct injury to the wrist or tendon, which may cause scar tissue that restricts movement of the tendons
3.Fluid retention, such as from changes in hormones during pregnancy
Risk factors
Risk factors for de Quervain tenosynovitis include:
1.Age. People between the ages of 30 and 50 have a higher risk of developing de Quervain tenosynovitis than do people in other age groups, including children.
2.Sex. The condition is more common in women.
3.Being pregnant. The condition may be associated with pregnancy.
4.Baby care. Lifting a child repeatedly involves using the thumbs as leverage and may be associated with the condition.
5.Jobs or hobbies that involve repetitive hand and wrist motions. These may contribute to de Quervain tenosynovitis.
Complications
When de Quervain tenosynovitis goes untreated, it can become difficult to use the hand and wrist properly. The wrist may lose some range of motion.
Treatment
De Quervain's tendinosis is treated by reducing the swelling/irritation of the tendons and tendon sheath, thereby relieving the pain caused by the condition.
Nonsurgical Treatment
1.Splints. A removeable splint that keeps the wrist straight and the thumb still in a comfortable position may improve pain, especially when worn at night.
2.Activity modification. Avoiding activities that cause pain and swelling may allow the symptoms to go away on their own.
3.Corticosteroids. An injection of corticosteroids into the tendon sheath can be effective in addressing the condition by reducing swelling and relieving pain. One or 2 injections has been shown to relieve the condition in 50 to 80% of patients.
Surgical Treatment
Surgery may be recommended if symptoms are severe or do not improve with non-operative management. The goal of surgery is to release the tendon sheath to make more room for the irritated tendons. When done correctly, this can relieve the symptoms of De Quervain's tenosynovitis without affecting hand/wrist function.
During surgery:
1.The surgeon first identifies and protects the nerves that live near the tendon sheath.
2.The surgeon then releases the sheath in a way that avoids tendon instability.
3.If there is excess tissue (tenosynovium) around the tendons, the surgeon will remove it.
4.The incision is then closed, and a bandage (and sometimes a splint) is applied.
Regardless of the treatment, you can usually resume normal use of the hand once comfort and strength have returned. Your orthopaedic surgeon can advise you on the best treatment for your situation.
Recovery
Most patients with De Quervain's tenosynovitis do very well and are ultimately relieved of their symptoms with nonsurgical and/or surgical treatment. Fifty to 80% of patients can be successfully treated nonsurgically with splints, NSAIDs, and injections. The remaining patients typically respond well to surgery.
Complications of surgery are rare. Patients with diabetes may be less successfully treated with injections and are more likely to have a surgical complication (infection, wound healing problems, etc.).
How is de Quervain’s tendinosis diagnosed?
The test most often used to diagnose de Quervain’s tendinosis is the Finkelstein test. Your doctor will ask you to make a fist with your fingers wrapped over your thumb. Keeping your hand in a fist position, the wrist is moved up and down — the motion of shaking someone’s hand. In this test, the swollen tendons are pulled through the narrowed sheath. If this movement is painful, you may have de Quervain’s tendinosis.
De quervain's tenosynovitis exercises
Finkelstein stretch
1.Hold your arms out in front of you. ...
2.Bend your thumb toward your palm.
3.Use your other hand to gently stretch your thumb and wrist downward until you feel the stretch on the thumb side of your wrist.
4.Hold for at least 15 to 30 seconds.
5.Repeat 2 to 4 times.
Will De Quervain's tenosynovitis heal on its own?
Overuse. This is the most common cause of de Quervain's tenosynovitis. Repetitive movements can cause irritation in the tissue. Sometimes, this can heal on its own without you noticing, but if you use the same motions too much for a long period of time, your body can't heal and the tears get worse.
How long does de Quervain's tenosynovitis take to heal?
Treatment for de Quervain tenosynovitis is aimed at reducing inflammation, preserving movement in the thumb and preventing recurrence. If you start treatment early, your symptoms should improve within 4 to 6 weeks.
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