De Quervain’s Tenosynovitis

De Quervain’s tenosynovitis is a condition in which the tendons on the inside of the wrist near the base of the thumb are inflamed (the extensor pollicis brevis and the abductor pollicis longus), causing pain with certain wrist and thumb movements.
What causes De Quervain’s Tenosynovitis?
De Quervain’s tenosynovitis is primarily caused by repetitive overuse of the wrist or thumb, causing the sheath around the tendons in that area to become inflamed.  The motion of pinching the thumb while moving the wrist from side to side is especially likely to cause inflammation leading to the condition.  De Quervain’s tenosynovitis can also be caused by a trauma to the wrist that causes inflammation or scar tissue to develop.  Certain medical conditions, such as rheumatoid arthritis, can also lead to the condition.
What are the symptoms of De Quervain’s Tenosynovitis?
The primary symptoms of de Quervain’s tenosynovitis are pain, swelling, tenderness and inflammation along the inside of the wrist near the base of the thumb.  Pain increases when the wrist is turned, the thumb is used to grasp or pinch anything, or a fist is made.  The pain may begin suddenly or may gradually increase over time.  In more severe cases, there may be numbness felt in the back of the thumb and index finger or it may be difficult to move the thumb when grasping objects due to the inflammation in the tendons.  A rubbing sound or sensation may also be noticed as the tendons move within the inflamed sheaths.
How is De Quervain’s Tenosynovitis diagnosed?
A medical professional will take a complete medical history and will perform a physical exam.  Questions will be asked about when the symptoms started, what increases or decreases pain and swelling, and what types of activities you regularly engage in that involve your wrist and thumb.  A test known as the Finkelstein maneuver may be performed, in which you bend your thumb across the palm of your hand, fold your fingers over your thumb and then bend your wrist towards your little finger.  Those with de Quervain’s tenosynovitis will experience pain on the side of the wrist closest to the thumb during this maneuver.
When should I seek care for De Quervain’s Tenosynovitis?
If you experience pain or swelling at the base of your thumb or inside of your wrist that does not improve with a period of rest, avoidance of activities that stress the wrist and thumb, and over the counter medications, you should seek medical advice.  If the pain is caused by a direct trauma to the wrist, the pain becomes severe, or you notice redness and warmth in addition to swelling, you should promptly see a medical professional.
What will the treatment for De Quervain’s Tenosynovitis consist of?
Treatment for de Quervain’s tenosynovitis may include rest (including immobilization of the thumb and wrist with a splint or brace), application of ice, and avoidance of any activities that repetitively use the thumb or wrist.  Nonsteroidal anti-inflammatory medication may be taken to reduce pain and swelling.   Cortisone injections are effective in diminishing inflammation in the tendons if other treatments are not effective.  In some cases, physical therapy is recommended and will include stretching and strengthening exercises involving the muscles in the hand, wrist and forearm.  Ergonomic assessments may also be performed to determine how you can perform certain tasks differently so that you do not cause the condition to recur.  Surgery is rarely needed, but when it is, a rehabilitation program must be followed after surgery to regain strength and flexibility.
Which muscle groups/joints are commonly affected by De Quervain’s Tenosynovitis?
De Quervain’s tenosynovitis affects the tendons located on the inside of the wrist near the base of the thumb.
What type of results should I expect from the treatment of De Quervain’s Tenosynovitis?
Most cases of de Quervain’s tenosynovitis will improve in a few weeks with conservative treatments, assuming that the activities that initially caused the inflammation are avoided.  If cortisone injections are needed, normal activity can typically be resumed in about three weeks following the injection.  Surgery is rarely performed, but when it is, the surgery is usually successful at treating the condition, although minor pain may persist for a few months after surgery.  In some cases, you may need to change the way you perform certain activities or wear a splint or brace during repetitive activities that stress the wrist and thumb in order to avoid a recurrence of the inflammation associated with de Quervain’s tenosynovitis.