De Quervain’s Tenosynovitis
De Quervain’s tenosynovitis is a painful condition affecting the thumb side of the wrist. Swelling of the tendons around the base of the thumb can irritate the sheath in which they move, resulting in difficulty squeezing, grasping or turning the wrist.
“De Quervain’s tenosynovitis is a condition we commonly see and treat in our practice,” says Check C. Kam, MD, FAAOS, a board-certified orthopaedic surgeon with South Florida Orthopaedics and Sports Medicine. “The pain is located along the thumb side of the wrist, and it can cause significant swelling.”
Causes of de Quervain’s Tenosynovitis
The actual causes of de Quervain’s disease remain a mystery. However, many physicians link it to overuse, a severe blow to the thumb, or any activity involving constant, repetitive hand or wrist movements such as gardening, hammering, playing golf, tennis, or even lifting heavy objects.
A common modern exacerbator of de Quervain’s is associated with increased text messaging. “Texting Thumb” can result from the awkward positioning or hyperextension of either thumb, causing tendons to become inflamed.
Pregnancy, diabetes, and inflammatory arthritic conditions such as rheumatoid arthritis have also been connected to de Quervain’s. “De Quervain’s is also known as “mommy’s wrist” because it often afflicts new mothers and causes pain when they lift up their child,” Dr. Kam explains.
Symptoms and Diagnosis
De Quervain’s can cause pain when turning or twisting the wrist. Patients may also experience pain and difficulty when grabbing something between their thumb and fingers. In some cases, patients may hear a squeaking, cracking, or snapping sound when they move the wrist or thumb. The bottom area of the thumb or the side of the wrist may also be sore or swollen, and sometimes the condition can cause a small bump which are commonly associated ganglion cysts on the thumb side of the wrist.
An orthopaedic hand and wrist specialist can diagnose de Quervain’s disease by feeling along the tendons on the thumb-side of the wrist for tenderness. They may also ask the patient to make a fist with their fingers clasped over their thumb and then to bend the wrist in the direction of the pinky finger. This maneuver is also known as the Finkelstein Test, and a patient with de Quervain’s will find the action very painful.
Treatment for de Quervain’s Tenosynovitis
The goal of treatment for de Quervain’s is to relieve swelling and pain in the wrist, which helps to restore normal function. If left untreated, the pain can spread up the forearm or down into the thumb.
“When I see de Quervain’s, I typically start by treating with a cortisone injection and a splint to immobilize the thumb and help reduce inflammation,” says Dr. Kam.
Other conservative treatment options for de Quervain’s can include:
- Use of nonsteroidal anti-inflammatory medications like ibuprofen or naproxen in either oral form or cream that can be applied to the affected area
- Cessation of any activities that exacerbate the condition
- Applying ice or heat to the concerned area
“If this initial treatment doesn’t work and the pain continues, or there’s a recurrence, I typically recommend a first dorsal compartment release,” says Dr. Kam. “This procedure can be performed safely as a wide-awake surgery using only local anesthesia. It takes about five to ten minutes to perform in an outpatient surgery setting.”
During a first dorsal compartment release surgery, the orthopaedic surgeon makes an incision below the tip of the radial styloid (the part of the wrist bone that protrudes just under the thumb) to open the first dorsal compartment. This releases the tendon sheath and relieves the constriction of the tendons that pass through it. Additionally, ganglion cysts are also excised if present. After the incision is closed with sutures, a splint is applied and then covered with an ace wrap.
“The recovery is typically fairly brief and requires about 7 to 10 days for the sutures to be removed. Therapy may or may not be needed depending on whether or not there is significant stiffness,” says Dr. Kam.
Occupational therapy can help patients learn how to use their wrist more efficiently to avoid recurrence. A physical therapist can help guide patients through gentle stretching exercises that can be helpful in preventing stiffness or other range of motion issues.
“Most patients do very well after this procedure,” affirms Dr. Kam.