De Quervain's Tendinosis

What is de Quervain's tendinosis?

De Quervain's tendinosis is a painful swelling (inflammation) of specific tendons of the thumb. The condition is also known as de Quervain tendinitis or de Quervain's tenosynovitis.

Tendons are bands of tissue that attach muscles to bones. Usually, tendons slide easily through a tunnel of tissue called a sheath. The sheath keeps the tendons in place next to the bones of the thumb. Tendons that easily slide through their sheaths allow the thumb to move without difficulty or pain.

Any swelling of the tendons and/or thickening of the sheaths cause friction. The tendons can no longer easily slide through their sheaths. When this happens, certain thumb and wrist motions become more difficult to do.

What are the symptoms of de Quervain's tendinosis?

Pain and tenderness along the thumb side of the wrist or directly over two specific tendons in the thumb is common in cases of de Quervain's. Pain worsens when the hand and thumb are in use. Pain can appear suddenly or develop over time. In either case, the pain may travel into the thumb or from the wrist to the lower arm (forearm). Thumb motion may be difficult and painful, particularly when pinching or grasping objects. You may feel a snapping or popping sensation feeling when moving the thumb.

Some people also experience swelling and pain on the side of the wrist at the base of the thumb. The pain may increase with thumb and wrist-twisting motion. Some people feel pain if direct pressure is applied to the area.

What causes de Quervain's tendinosis?

Overuse, a direct blow to the thumb, repetitive grasping and certain inflammatory conditions (such as rheumatoid arthritis), can all trigger the tendinosis. Gardening, racquet sports, and various workplace tasks are some activities that may aggravate the condition. Often, its cause is unknown. De Quervain's affects women eight to 10 times more often than men.

How is de Quervain's tendinosis diagnosed?

The test most often used to diagnose De Quervain's tendinosis is the Finkelstein test. Your doctor will ask you to make a fist with your fingers wrapped over your thumb. Keeping your hand in a fist position, the wrist is moved up and down the motion of shaking someone's hand. In this test, the swollen tendons are pulled through the narrowed sheath. If this movement is painful, you may have De Quervain's tendinosis.

How is de Quervain's treated?

Non-surgical treatments include:

• Using splints. Splints may be worn to rest the wrist and thumb and keep it from moving. Splints are usually worn 24 hours a day for 4 to 6 weeks.
• Applying ice to thumb and wrist area to reduce swelling.
• Avoiding activities that are causing pain and swelling.
• Taking medications. If symptoms continue, your doctor may give you anti-inflammatory medication, such as naproxen or ibuprofen, to decrease pain and swelling. Steroid injection(s) into the tendon sheath may also be considered.

Surgery

If non-surgical treatments do not help relieve pain and swelling, surgery may be recommended.

Surgery for de Quervain's tendinosis is an outpatient procedure done under local anesthesia. During the surgery, a tiny cut is made in the sheath through which the tendons pass. Cutting the sheath allows more room for the tendons to slide more easily through the sheath. The goal of this surgery is to eliminate pain and swelling and restore the range of motion to the thumb and wrist.

Upon recovery, your physician will recommend an exercise program to strengthen your thumb and wrist. Recovery times vary, depending on your age, general health, and how long the symptoms have been present.

In cases that have developed gradually, the tendinosis is usually more difficult to manage. It may take longer for symptoms to disappear and for the thumb and wrist to regain their range of motion.