De Quervain tenosynovitis
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De Quervain tenosynovitis is one of the most known types of tendon lining inflammation. It is a painful swelling that affects the wrist tendons on the side of the thumb. De Quervain causes pain when you grasp things and turn or twist your wrist if you have the condition.
Tendons are tissue bands that connect muscles to bones. Tendons normally glide effortlessly through a tunnel of tissue known as a sheath. With de Quervain tenosynovitis, the tendons become inflamed or thickened, which causes friction. Tendons can no longer pass easily through their sheaths. One will most likely experience pain when turning the wrist, grasping anything, or making a fist.
De Quervain tenosynovitis may be triggered by repetitive grasping or activities that demand a sideways wrist motion while gripping with the thumb, such as gardening, golf, racket sports, or lifting a baby. However, the definite cause of this condition is still unknown. Common treatments include splints and surgery.
Symptoms
Symptoms of de Quervain tenosynovitis may include:
- Tenderness and pain down the side of the wrist on the thumb side
- Thumb swelling towards the base
- Pain or discomfort when moving the thumb, especially when grabbing or squeezing objects
- Snapping or popping feeling in the wrist when moving the thumb
- Pain that worsens when using the hand and thumb
- Pain that arrives suddenly or gradually
- If left untreated, pain that spreads from the wrist to the lower arm or into the thumb (forearm)
It is recommended to consult a healthcare professional if the symptoms of de Quervain tenosynovitis persist despite applying first-aid treatment such as taking Non-Steroidal Anti-Inflammatory (NSAIDs), applying ice to the affected area, and refraining from using or moving the thumb. The doctor will need to examine the area for correct diagnosis.
Causes
Tendons are the structures that connects muscle to bone. A tunnel of tissue known as sheath keeps the tendons in place next to the bones of the thumb. With de Quervain tenosynovitis, two tendons on the wrist’s thumb are inflamed.
The thickness and swelling make it difficult for the tendons to pass through the sheath, which connects them to the base of the thumb. Chronic overuse, such as performing the same hand action daily, may aggravate the covering around the tendons.
De Quervain tenosynovitis can also be caused by:
- Inflammatory conditions such as arthritis
- Trauma to the wrist or tendon, resulting to scar tissue that inhibits tendon movement
- Fluid retention caused by hormonal changes during pregnancy
Risk factors
Several risk factors may increase one’s risk of having de Quervain tenosynovitis, such as:
- Age: Compared to other age groups, including children, people between the ages of 30 and 50 are more susceptible to de Quervain tenosynovitis.
- Sex: This condition affects women eight to 10 times more often than men.
- Being pregnant: Hormonal changes during pregnancy can trigger this condition.
- Baby care: The condition may be related to frequently lifting a child, who often requires using the thumbs as leverage.
- Repetitive hand and wrist movements: Engaging in hobbies or jobs that require repetitive movements can trigger de Quervain tenosynovitis.
Diagnosis
De Quervain tenosynovitis does not usually require imaging tests such as X-rays to be diagnosed. Instead, the doctor will evaluate the hand and press on the thumb side of the wrist to determine whether the patient will feel discomfort. Additional tests may be required to confirm the diagnosis:
- Finkelstein test: This is commonly used to assess de Quervain’s tendinosis. The aim is to see if the movement will cause pain. This would mean that the enlarged tendons are dragged through the narrower sheath which confirms de Quervain’s tendinosis.
- During the test: the doctor will instruct the patient to create a fist with all fingers wrapped around the thumb. Keeping the hand in a fist, move the wrist up and down in the motion of shaking someone’s hand. The patient most certainly has de Quervain tenosynovitis if this movement creates pain on the thumb side of the wrist.
Treatment
Treating de Quervain tenosynovitis right away will improve the symptoms within 4 to 6 weeks. Pregnancy-related de Quervain tenosynovitis will most likely go away after pregnancy.
Generally, the goal of treatment is to reduce inflammation, restore thumb mobility, and lessen the chance of the condition happening again after treatment. De Quervain’s tendinosis may be treated with surgical and non-surgical methods.
- Medications: The doctor may prescribe anti-inflammatory medication such as naproxen or ibuprofen to reduce discomfort and inflammation. Injections of steroids (or corticosteroids) into the tendon sheath may also be considered.
Most patients fully recover after receiving corticosteroid injections, frequently after only one injection, if treatment begins during the first six months of symptoms. - Therapies: People with de Quervain tenosynovitis may visit a physical or occupational therapist to discuss how to utilize the wrist and relieve wrist tension. Several exercises can help develop the muscles while reducing discomfort and tendon inflammation.
First-line treatment for de Quervain tenosynovitis may begin with the following:- Using splints to aid in restraining the thumb and wrist from moving and keeping the tendon in place until it heals completely. Splints are typically worn 24 hours a day, seven days a week for four to six weeks.
- Avoiding activities or repetitive thumb movements that cause pain and swelling.
- Avoiding squeezing the wrist from side to side with the thumb.
- Using ice on the thumb and wrist to minimize swelling.
- Surgery or other procedures: Surgery is often recommended if non-surgical treatments have failed to relieve the symptoms of de Quervain tenosynovitis. The surgery is performed as an outpatient procedure under local anesthesia.
During the surgery, the surgeon examines the sheath enclosing the affected tendon or tendons before opening it to relieve pressure. Cutting the sheath permits the tendons to move more freely through the sheath. The purpose of this procedure is to relieve discomfort and inflammation while restoring thumb and wrist range of motion.
Following surgery, a physical therapist or occupational therapist may visit the patient to give appropriate strengthening exercises and assist with adapting to the daily routine to avoid future difficulties. Specifically, the doctor will suggest an exercise plan to rehabilitate the thumb and wrist. Recovery timeframes vary depending on one’s age, general health, and the duration of the symptoms.
It is also critical to follow the doctor’s recommendations regarding which activities aggravate the disease and which should be avoided. Limiting these movements may help prevent future de Quervain’s tendinosis complications.
