De Quervain’s Tenosynovitis


 

What Is De Quervain’s Tenosynovitis?

De Quervain’s tenosynovitis refers to pain in the tendons beneath the thumb that lead down to the wrist. Irritation from overuse can lead to swelling in the sheath enclosing the tendon, or in the soft protective tissue on the tendon itself. This swelling allows less room for the tendon to glide, causing friction and pain during movement.

The condition is most common in women over 40, especially those whose work or activities include repetitive hand and wrist movements. Excessive typing, practicing a musical instrument, or playing tennis can put you at risk for this condition. It is also associated with hormonal changes and fluid retention during pregnancy, as well as inflammation due to arthritis. While similar in some ways to carpal tunnel syndrome, this condition does not involve nerve damage.

 

De Quervain’s Tenosynovitis Symptoms

If you’re suffering from de Quervain’s tenosynovitis, pain may arise over time or appear suddenly. Discomfort is generally localized in the wrist beneath your thumb, but it can move into your forearm as well. The pain may worsen when you make certain motions, such as grasping, twisting, or forming a fist. There may be swelling beneath the thumb, where you can develop a fluid-filled cyst. When you rotate your thumb, you may feel like it catches, or doesn’t move smoothly.

 

De Quervain’s Tenosynovitis Treatment

Your first line of treatment should be icing the area and taking anti-inflammatory medications to reduce swelling. If the pain does not subside after a week or two of rest, you should consult an orthopedic specialist. To confirm the diagnosis you will likely need to perform the Finkelstein test, in which you make a fist with your thumb tucked beneath the fingers, then bend at the wrist toward the little finger. Sharp pain in the wrist indicates de Quervain’s.

Your doctor may start with cortisone shots to reduce the swelling. A physical therapist can also teach you exercises to strengthen the area and avoid further aggravation. If the condition does not improve with these conservative measures, you may need surgery to open the sheath and relieve pressure on the tendons.

 

De Quervain’s Tenosynovitis Recovery Time

With conservative treatments, your symptoms may improve within four to six weeks. If de Quervain’s is due to pregnancy, you can expect symptoms to subside a few weeks after pregnancy or breastfeeding. After surgery, swelling and soreness in the thumb generally subside within a few days, but can persist during the healing process. You may need a splint for up to a month after surgery, with the hand taking six to 12 weeks to fully heal. During this time, you should refrain from activities that may aggravate the area. If physical therapy is required, you can expect to spend a few additional weeks working on exercises that strengthen the hand and wrist.

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