What Is De Quervain's Tenosynovitis?

De Quervain's Tenosynovitis is a painful condition that affects the tendons on the thumb side of the wrist. The condition causes pain when you rotate your wrist, make a fist, or grasp an object. Tenosynovitis refers to the swelling of your tendons.

Your doctor may also refer to this condition as Tenosynovitis, De Quervain, De Quervain Syndrome, or Radial Styloid Tenosynovitis. There is no known exact cause of De Quervain Tenosynovitis. Repetitive hand or wrist movements can make the condition worse.

De Quervain’s Tenosynovitis affects:

• Your thumb
• Your hand
• Your wrist

Signs & Symptoms

If you develop De Quervain’s Tenosynovitis, you will likely experience noticeable signs and symptoms. The main symptom is pain in your thumb, hand, and wrist. Left untreated, the pain can spread deeper into your thumb and forearm. You may also experience severe pain.

Additional Tenosynovitis symptoms include:

• Targeted pain—You will likely feel pain at the bottom of your thumb.
• Swollen thumb—The base of your thumb might swell.
• Difficulty with movement—You may notice increased difficulty performing thumb and wrist motions that involve a pinching or grasping movement.
• Sticking sensation—When you move your thumb, you may feel a “sticking” or “catching” sensation. It may seem as if your thumb temporarily stops working or does not want to move.

Causes

While there is no known specific cause of De Quervain’s Tenosynovitis, there are several factors associated with the development of the condition. Generally, De Quervain's Tenosynovitis occurs when there is irritation or injury to the tendons connected to the base of your thumb.

De Quervain's Tenosynovitis causes include:

• Repetitive motions—For example, typing on a keyboard, using a screwdriver, lifting objects, and playing the piano.
• Injuries—Direct trauma to your thumb, hand, or wrist is associated with Tenosynovitis.
• Pre-existing conditions—Certain conditions such as rheumatoid arthritis can proceed De Quervain's Tenosynovitis. Arthritis can cause swelling, fluid retention, and thickening of your wrist joint.

Risk Factors

There are several risk factors for De Quervain's Tenosynovitis.

Risk factors include:

• Age—Individuals between 30-50 years old are at higher risk of De Quervain's Tenosynovitis. However, anyone can develop the condition.
• Gender—Women are more susceptible to De Quervain's Tenosynovitis than men.
• Pregnancy—During pregnancy, hormonal changes can cause swelling in the wrists, hands, and fingers. This swelling makes you more vulnerable to the condition.
• Baby Care—Caring for a baby often involves lifting and carrying the child, movements that engage your thumbs, hands, and wrists.
• Job/Career—Any job that includes repeatedly gripping, pinching, grasping, wringing, or clenching motions can lead to Tenosynovitis.
• Lifestyle—Activities such as knitting, crocheting, playing the piano, rock climbing, tennis, gymnastics, golfing, or weightlifting can contribute to this condition.

Diagnosis

The Finkelstein test is the most frequent test to diagnose De Quervain's Tenosynovitis. Your doctor will instruct you to form a fist with your thumb tucked underneath your fingers.

Your doctor will move your wrist up and down as you keep your hand in a fist position—similar to the gesture of shaking someone's hand. During this examination, the inflamed tendons are pulled through the narrowed tendon sheath. If this motion hurts, your doctor may make a Tenosynovitis diagnosis.

Depending on the exact location and symptoms of your condition, your doctor might diagnose you with Tenosynovitis wrist, Tenosynovitis hand, or Tenosynovitis finger.

Treatment

The three main Tenosynovitis treatments are medication, therapy, and surgery. These three treatments can sometimes be used in combination.

The treatments focus on decreasing symptoms, reducing inflammation, and returning normal functioning. If you treat the condition early, most symptoms resolve in under six weeks.

Medication

You doctor may recommend pain relievers to reduce pain and swelling. Your doctor may also suggest corticosteroid injections for swelling. One injection is sometimes enough to relieve symptoms.

Therapy

You may receive treatment from an occupational therapist or a physical therapist.

Physical therapy can involve:

• Immobilization—You might receive a brace or stint to immobilize your wrist and thumb.
• Ice—Placing ice on your thumb, hand, and wrist can help reduce swelling and pain.
• Avoiding movements—Your physical therapist will likely recommend that you try to avoid repetitive movements that cause you pain.

Surgery

Surgery for De Quervain's Tenosynovitis is done with local anesthesia or sedation. It is usually an outpatient surgery that takes 30 minutes. It is helpful to arrange for someone to drive you to and from the appointment.

A small incision is made in the tendon sheath during the procedure. This makes it simpler and less painful for the tendons to move within and through the sheath. The ultimate goal of the surgery is to reduce pain and swelling while restoring your thumb's range of motion.

After surgery, you will wait in a recovery area until your anesthesia wears off and your doctor clears you to go home. A physical therapist will discuss ways to help you strengthen and rehabilitate your thumb, wrist, and hand. It can take a few weeks of rest before you can return to your regular activities, such as driving and typing. However, depending on the nature of your job, you may be able to return to work a few days after surgery.

If you or your family have questions about De Quervain's Tenosynovitis, please contact an orthopedic specialist at Baptist Health today.