De Quervain's Tendinitis
A tendon is a thick band of connective tissue that connects bone to muscle. Tendons are contained within a sheath, through which they slide freely in normal circumstances.
The hand and wrist contain a number of tendons and these play an important part in providing movement, dexterity and function.
Inflammation of a tendon is known as tendinitis. While tendinitis can affect any tendon in the hand or wrist, De Quervain’s tendinitis (also known as De Quervain’s tenosynovitis) is a condition in which two of the tendons attached to the thumb become painful and inflamed where they cross at the base of the thumb.
De Quervain's tendinitis can often be managed well using conservative (non-surgical) methods although surgery may be needed in certain circumstances.
The exact cause of De Quervain's tendinitis is not yet fully understood, although there are some things that increase the risk of experiencing it. It often occurs as a result of doing something unusual which has aggravated the tendons, such as five hours of gardening where you usually do none.
It is also very common in mothers of young babies between birth and six months. While breastfeeding, they will often hold the head of the baby firmly against the breast. This action, done repetitively over a period of time, will irritate the two tendons
De Quervain's tendinitis tends to cause pain specific to the base of the thumb, where the wrist and lower forearm meet.
This area may be a bit swollen and there might be some creaking or crackling when you move your thumb. This can be quite alarming, especially if you haven’t had this happen before, but it is a very common occurrence. Known as crepitus, it occurs when an inflamed tendon moves through the tendon sheath. Some people say crepitus feels a bit like having bubble wrap in the wrist.
These symptoms are often aggravated by any movement that involves the tendons and muscles in the thumb, which can be as varied as carrying a bag through to using a smartphone. We use our thumbs and wrists so much more than we think we do as part of our everyday activities and this is what can make De Quervain's tendinitis such a challenging problem to live with.
Diagnosis is made by clinical examination. When people first come to see me, they will often complain of pain on the outside of the wrist (this is known as the radial aspect). This pain can be made worse when they extend their thumb against resistance (resisted extension).
If there is any doubt about the diagnosis, I will arrange for either an ultrasound or an MRI scan. An ultrasound can show fluid around the tendons in the sheath. In some cases, there won’t be any fluid, and the ultrasound may not pick anything up. In these cases, an MRI scan can be helpful as it will show inflammation even if it's dry. If there is increased tissue circulation it will pick up any tissue swelling (oedema).
In advance of seeing me, most people will already have gone to their GP for help and advice. They may already have tried non-surgical treatments such as splinting to help reduce inflammation and pain. Their GP may also have given them a cortisone injection, and this can often help to alleviate symptoms, although the effects of this may wear off over time.
There may be benefits in having these injections done by a specialist rather than your family doctor. The anatomy around the wrist can be pretty confusing and the danger of hitting an important structure inadvertently with the tip of the needle is real.
If you come to see me and you haven’t already had a cortisone injection, I would generally recommend you have one to see if it helps. Should these injections not be of much help, or if they’ve stopped having an effect, I would talk with you about surgery to release the tendon sheath.
This surgery is carried out under local anaesthetic. I will make a small cut in the skin of your wrist and then in the tendon sheath. This will ‘release’ the tendons i.e. it will enable them to move freely without being impinged on. It will also allow me to carefully inspect the tendons.
After the operation, your wrist will be covered with a cotton wool dressing and elastic bandage. You should expect to be a bit stiff and sore in the wrist after the operation, and it’s important to give yourself time to recover properly. If you have a manual job, you may need to take some time off work.
For anybody with De Quervain’s tendinitis, even simple jobs such as lifting something up, holding a bag or using a smartphone can become difficult and extremely painful.
It’s important to get expert help in managing any tendinitis. My priority is always to help to get you out of pain first, and then to work on restoring function to your hand and wrist. It’s easy to arrange a consultation with me at Circle; please contact my private secretary to book a time that is most convenient for you.
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