De Quervain Tenosynovitis

What is De Quervain Tenosynovitis?

De Quervain Tenosynovitis or De Quervain’s Tendinosis or De Quervain’s disease is a condition when two tendons, the abductor pollicis longus (APL) and extensor pollicis brevis (EPB), become inflamed as they pass through a tunnel formed by the radius bone and a thick fibrous tissue called extensor retinaculum forms the roof.

Risk Factors and Causes of De Quervain Tenosynovitis

• Repetitive Movements: Repetitive wrist or thumb movement, like gardening, playing instruments, or racquet sports, can lead to tendon overuse and inflammation.
• Direct Injury or Acute Trauma: Wrist or tendon injuries can cause inflammation, thickened tendons, and scar tissue, which restrict tendon movement.
• Inflammatory Conditions: Conditions like rheumatoid arthritis can lead to De Quervain Tenosynovitis by causing inflammation in the tendons and their sheaths.
• Hormonal Factors: Hormonal changes in pregnancy and breastfeeding may raise the risk of De Quervain Tenosynovitis. Hence why it is sometimes referred to as "mommy thumb".
• Age and Gender: Women are more likely to develop De Quervain Tenosynovitis than men, and it is most commonly diagnosed in individuals aged 30 to 50.

Symptoms of De Quervain Tenosynovitis

• Pain at the Base of the Thumb: The main symptom is sharp pain on the thumb side of the wrist, which gets worse with movements like grasping. Pain during the Finkelstein and Eichhoff tests is a strong sign of this condition.
• Swelling Near the Base of the Thumb: Inflammation of the tendons can cause visible swelling at the base of the thumb. The swollen area may feel tender to the touch.
• Difficulty Moving the Thumb and Wrist: De Quervain Tenosynovitis makes it hard to move your thumb and wrist, especially during repetitive tasks like grasping or making a fist.
• A Sticking or Snapping Sensation: Some people may feel a snapping sensation in their thumb when inflamed tendons rub against a narrowed sheath.
• Decreased Grip Strength: The pain and inflammation can lead to a decrease in grip strength, making it challenging to hold or lift objects.
• Radiating Pain: Pain may radiate from the thumb side of the wrist up the forearm. This radiating pain can be persistent or occur intermittently, depending on the activity level and severity of the condition.

Diagnosis of De Quervain Tenosynovitis

• Medical History: The healthcare provider will review your symptoms, medical history, and activities to identify risk factors for De Quervain Tenosynovitis.
• Physical Examination: The provider checks the thumb and wrist for swelling, tenderness, pain, limited movement, and range of motion.
• Finkelstein Test: The Finkelstein test is a simple way to diagnose de Quervain's tenosynovitis. To perform it, make a fist with your thumb tucked inside and bend your wrist toward your little finger. If you feel pain on the thumb side of your wrist, it may indicate the condition.
• Imaging Tests: X-rays or ultrasounds can help check for fractures, arthritis, or inflamed tendons that might be causing wrist pain.

De Quervain Tenosynovitis Treatment

• Non-surgical Treatments:
  • Splinting: Wearing a splint or brace that immobilises the thumb and wrist can provide relief by minimising movement and giving the tendons time to heal. Splints are typically worn for several weeks.
  • Anti-inflammatory Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can help reduce inflammation and pain.
  • Corticosteroid Injections: Corticosteroids can be injected directly into the tendon sheath to reduce inflammation. This treatment is often very effective and can provide relief for several months.
  • Physiotherapy: A physiotherapist can provide exercises to strengthen the thumb and wrist, improve range of motion, and relieve pain. They may also use techniques such as ultrasound or heat therapy to promote healing.
  • Activity Modification: Making changes to how you perform daily activities, such as using ergonomic tools or altering your hand positions, can help prevent further strain on the tendons.

   

• De Quervain Tenosynovitis Release Surgery: Surgery for De Quervain Tenosynovitis is recommended when symptoms are severe or don’t improve with other treatments. The procedure involves a small incision on the thumb side of the wrist to release the tendon sheath, which helps reduce pressure, friction, and inflammation.

De Quervain Tenosynovitis Exercises

• Thumb Stretch: Stretch your arm out in front of you with your palm facing up. With your other hand, gently pull your thumb back away from your palm to stretch the tendons on the thumb side of your wrist. Hold for 15–30 seconds and repeat 2–3 times.
• Wrist Flexor Stretch: Stretch your arm out in front of you with your palm facing down. With your other hand, gently push your wrist down so your palm moves towards the floor. Hold for 15–30 seconds and repeat 2–3 times.
• Wrist Extensor Stretch: Stretch your arm out in front of you with your palm up. With your other hand, gently press your fingers down toward the floor to bend your wrist. Hold the stretch for 15–30 seconds and repeat 2–3 times.
• Thumb Abduction Strengthening: Place your hand flat on a table with your palm facing up. Wrap a rubber band around your fingers and thumb. Slowly move your thumb away from your fingers, stretching the rubber band. Hold for a few seconds, then return to the starting position. Repeat 10–15 times.
• Radial Deviation Strengthening: Hold a lightweight object, like a small dumbbell or a can, in your hand with your thumb pointing up. Move your wrist up and down slowly, keeping your thumb aligned with your forearm. Repeat this movement 10–15 times.
• Tendon Gliding Exercises: Begin with your hand in a neutral position, fingers straight. Slowly close your hand into a fist, then open it back to the starting position. Next, bend your fingers to touch their tips to the base of your palm, then return to the starting position. Finally, bend your fingers to press the pads to the base of your palm, and return to the starting position. Repeat this sequence 5–10 times.

De Quervain’s Tenosynovitis vs Carpal Tunnel

Preventing De Quervain Tenosynovitis Recurrence

De Quervain Tenosynovitis causes radial-sided wrist pain and swelling on the thumb, often from repetitive wrist motion. To prevent it from coming back, focus on good ergonomics, regular breaks, and wrist-strengthening exercises.

At Prince Court Medical Centre, our orthopaedic specialists offer advanced treatments and personalised care to help you recover. Take control of your pain today!

Share: