Definition
De Quervain’s Tendinitis is the inflammation of the tendons around the base of the thumb. Irritation and thickening of the tendons can cause pain and discomfort along the thumb site of your wrist. The pain or discomfort is noticeable especially when turning the wrist, forming a fist or grasping an object. This condition is usually seen commonly in middle-aged women.
Two main tendons of the thumb run side by side through a tunnel (or series of pulleys) along the thumb side of the wrist. These tendons run through a layer called synovium – a layer that allows easy sliding of the tendons. Any swelling of the tendons can put pressure on the nerves, this will cause pain or numbness of the wrist.
Symptoms
Symptoms of De Quervain’s Tendinitis include :
- Pain near the base of the thumb. The pain may appear suddenly or gradually, and increase over time. If the condition progresses without having appropriate treatment, the pain may spread further up into the thumb or back down towards the forearm. Any hand and thumb motions increases pain.
- Swelling may be seen over the thumb side of the wrist. The swelling is usually associated with a fluid-filled cyst in this region.
- A “catching” or “stop-and-go” sensation when trying to move the thumb.
- Numbness may be experienced along the thumb side of the wrist due to the nerve near the tendon sheath being irritated.
- A “squeaking” sound as the tendons move between the inflamed sheaths.
Causes
The normal tendons glide smoothly through the small tunnel along the thumb side of the wrist. In De Quervain’s Tendinitis, the lining (synovium) swells due to irritation, thus preventing the tendons to move as they should.
Overuse of the wrist is frequently associated with tendinitis. Repetitive activity such as wringing the cloth or mop requires constant wrist bending and gripping of the object. If you repeat this manoeuvre day by day, this will be enough to cause irritation to the tendon sheath.
Other causes include:
- Any injury or fracture around the wrist will increase stresses across the tendons; scar tissue can also restrict tendon movements.
- Pregnancy: due to hormonal fluctuations.
- Inflammatory arthritis such as: rheumatoid arthritis.
- Others: calcium apatite deposition disease.
Risk Factors
Individuals whose occupations or hobbies depend on repetitive hand movements or wrist motions, such as musicians, carpenters, gardeners, office workers and hairdressers. New parents are also prone to this type of tendinitis, as their awkward hand and wrist positions in handling children may aggravate the condition.
Other risk factors include being female and age 30-50.
Investigations
To diagnose De Quervain’s Tendinitis, your doctor may perform the following tests:
- Open and close your hand to assess full and smooth movements of the thumb. Smooth, full, and painless movement of the thumb virtually excludes De Quervain’s Tendinitis.
- Pain or discomfort when pressure is applied on the thumb side of the wrist.
- Feel for swelling at the thumb side of the wrist (anatomical snuff box) and compare it with the uninvolved side.
- Making a fist with the fingers closed over the thumb and the wrist is bent toward the little finger – Finkelstein Test. If this causes pain on the thumb side of the wrist, then the test is positive. This manoeuvre can be quite painful for the person with De Quervain’s Tendinitis.
Complications
As the condition progresses, you may begin to limit your hand and wrist movements due to the pain or discomfort. This might affect your daily tasks such as gripping objects or opening a jar. Lack of movements may aggravate the pain, reduce flexibility of the hand and restrict range of motion.
Treatment
The goal is to relieve the pain or discomfort caused by irritation and swelling. Your doctor may recommend non-surgical or surgical treatment:
Non-Surgical:
- Immobilization of thumb and wrist by using a splint.
- Avoiding activities that involve repetitive thumb movement, or that cause pain or swelling; Symptoms might resolve on their own.
- Applying ice to the affected site.
- Medication: Anti-inflammatory medications such as NSAID’s (ibuprofen or naproxen) can reduce swelling and pain.
- Injections of steroids into the tendon compartment to reduce swelling.
When your condition progresses and symptoms get more severe or do not improve, your doctor may recommend surgical treatment.
Surgical:
- Your doctor will open the compartment (sheath), release the pressure and make more space for the inflamed and irritated tendons. This is essential as it breaks the vicious cycle where the tight space creates more inflammation. Normal use of the hand can be resumed once strength and comfort have returned.
Seeking Advice
Your Family Doctor (GP)
Your Family Doctor will be able to diagnose and help treat your problem. He or she will be able to
- tell you about your problem
- advise you of the best treatment methods
- prescribe you medications
- and if necessary, refer you to Specialists (Consultants) for further treatment
Prevention
There isn’t a clear and define way to prevent De Quervain’s Tendinitis. It may help if you avoid the following actions:
- Twisting or wringing motions
- Heavy grasping
- Pinching with your thumb while moving your wrist side by side
F.A.Q. | Frequently Asked Questions
What is the prognosis?
If you start treatment early on, your symptoms of De Quervain’s Tendinitis should generally improve within 4 – 6 weeks.
Rehabilitation
Your doctor will recommend you to a physical therapist to teach you about strengthening exercises of your hand. This will reduce pain, strengthen your muscle, limit tendons irritation and restore hand movements. An occupational therapist will help you adjust your daily routine which includes reviewing your habits and giving advice on how to reduce stresses on your wrist, thus preventing recurrence of this condition.