De Quervain’s Tenosynovitis
De Quervain’s tenosynovitis describes a condition in which 2 of the tendons attached to the thumb become painful and inflamed as they cross the wrist joint at the base of the thumb.
It arises when the 2 tendons ( extensor pollicis brevis and abductor pollicis longus) become inflamed as they cross the wrist joint usually as a result of repetitive activity at the wrist. The 2 muscles are located in the lower forearm and run across the wrist to attach at the thumb. The tendons are contained in a sheath, under normal circumstances they freely slide through to produce the thumb movements needed, but if subject to excessive repetitive activity they become painful and inflamed . It is not known exactly why this occurs but this condition occurs commonly in people doing repetitive activity at the wrist eg bar staff and occurs during pregnancy or post-partum possibly as a result of hormonal changes or excessive lifting of the newborn baby.
Focal pain is felt directly over the tendon sheath (in the thumb side of the wrist and lower forearm). There is sometimes some associated swelling throughout this same area and in severe cases, there may be some creaking (known as crepitus) when using muscles and tendons of the thumb. Symptoms are aggravated by any use of the muscles and tendons of the thumb, most commonly felt with lifting, carrying and using smartphones.
De Quervain’s tenosynovitis can be reliably diagnosed by your doctor or physiotherapist by taking a history of your condition and by conducting a physical examination. The main feature on examination is pain and palpation in the tendon sheath and pain when stretching and loading the thumb tendons (Finklestein’s test). X-rays and scans are not routinely required but may be requested if symptoms have not responded to a course of non-surgical management.
De Quervain’s tenosynovitis can be managed very effectively in almost all cases with non-surgical management.
Modifying aggravating activities
Modifying any wrist and hand positions used for lifting or reducing any sustained period of time with touch screen devices such as tablets and smartphones may also allow any inflammation and pain to settle in the tendons and sheaths
The application of anti-inflammatory gel to the painful area may ease pain and help settle the inflammation. Similarly ice , applied appropraitely through a damp cloth for short periods to avoid an ”ice burn” may ease symptoms
Wearing a splint supports the thumb and allows any inflammation and pain in the tendons and sheath to settle.
A referral may be suggested as an alternative to injection in some cases or if advice is needed on activity modification
Corticosteroid injection therapy
For individuals with De Quervain’s tenosynovitis who continue to suffer disabling symptoms in spite of appropriate use of splints and activity modification a corticosteroid injection can be offered as the next line of treatment. You can read more about local corticosteroid injections here.
De Quervain’s decompression surgery is an effective option for individuals who:
- Have trialled a course of non-surgical management without success
- Have consistent, disabling pain significantly limiting mobility or affecting sleep pattern
- Have ultrasound imaging confirming the diagnosis