de Quervain's Tenosynovitis: Symptoms, Causes, Diagnosis and Treatment

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De Quervain's tenosynovitis is a painful condition affecting the tendons on the thumb side of your wrist. If you have de Quervain's tenosynovitis, it will probably hurt when you turn your wrist, grasp anything or make a fist.

Although the exact cause of de Quervain's 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 your baby — can make it worse.

De Quervain's Tenosynovitis 

Symptoms

Symptoms of de Quervain's tenosynovitis include:

  • Pain near the base of your thumb
  • Swelling near the base of your thumb
  • Difficulty moving your thumb and wrist when you're doing something that involves grasping or pinching
  • A "sticking" or "stop-and-go" sensation in your thumb when moving it

Causes

Chronic overuse of your wrist is commonly associated with de Quervain's tenosynovitis.

Tendons are rope-like structures that attach muscle to bone. When you grip, grasp, clench, pinch or wring anything in your hand, two tendons in your wrist and lower thumb normally glide smoothly through the small tunnel that connects them to the base of the thumb. Repeating a particular motion day after day may irritate the sheath around the two tendons, causing thickening and swelling that restricts their movement.

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

Risk factors

Risk factors for de Quervain's tenosynovitis include:

  • Age. If you're between the ages of 30 and 50, you have a higher risk of developing de Quervain's tenosynovitis than do other age groups, including children.
  • Sex. The condition is more common in women.
  • Being pregnant. The condition may be associated with pregnancy.
  • Baby care. Lifting your child repeatedly involves using your thumbs as leverage and may also be associated with the condition.
  • Jobs or hobbies that involve repetitive hand and wrist motions. These may contribute to de Quervain's tenosynovitis.

Diagnosis

To diagnose de Quervain's tenosynovitis, your doctor will examine your hand to see if you feel pain when pressure is applied on the thumb side of the wrist.

Your doctor will also perform a Finkelstein test, in which 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, you likely have de Quervain's tenosynovitis.

Imaging tests, such as X-rays, generally aren't needed to diagnose de Quervain's tenosynovitis.

Treatment

Treatment for de Quervain's tenosynovitis is aimed at reducing inflammation, preserving movement in the thumb and preventing recurrence.

If you start treatment early, your symptoms should improve within four to six weeks. If your de Quervain's tenosynovitis starts during pregnancy, symptoms are likely to end around the end of either pregnancy or breast-feeding.

Medications

To reduce pain and swelling, your doctor may recommend using over-the-counter pain relievers, such as ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve).

Your doctor may also recommend injections of corticosteroid medications into the tendon sheath to reduce swelling. If treatment begins within the first six months of symptoms, most people recover completely after receiving corticosteroid injections, often after just one injection.

Therapy

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 as much as possible
  • Avoiding pinching with your thumb when moving your wrist from side to side
  • Applying ice to the affected area

You may also see a physical or occupational therapist. These therapists may review how you use your wrist and give suggestions on how to make adjustments to relieve stress on your wrists. Your therapist can also teach you exercises for your wrist, hand and arm to strengthen your muscles, reduce pain and limit tendon irritation.

Surgery

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 the pressure so your tendons can glide freely.

Your doctor will talk to you about how to rest, strengthen and rehabilitate your body after surgery. A physical or occupational therapist may meet with you after surgery to teach you new strengthening exercises and help you adjust your daily routine to prevent future problems.

Lifestyle and home remedies

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

  • Avoid moving your wrists the same way repeatedly.
  • Wear a brace or splint if suggested by your doctor.
  • Follow through with recommended exercises.
  • Note activity that causes pain, swelling or numbness in your thumb and wrist, try to avoid it, and share that information with your doctor.

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