De Quervain’s Tendinosis
Overview
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. DeQuervain’s was named after the Swiss surgeon who first described the condition in 1895.
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. The pain may extend from the forearm to the thumb base.
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.
How common is de Quervain’s tendinosis?
De Quervain’s tendinosis is one of the most common types of tendon lining inflammation (swelling). This condition affects women eight to 10 times more often than men.
Symptoms and Causes
What causes de Quervain’s tendinosis?
De Quervain’s tendinosis can be triggered by several factors, including:
- Overuse.
- A direct blow to the thumb.
- Repetitive grasping.
- Inflammatory conditions (including arthritis).
Activities that require a sidewise motion of the wrist while you are gripping with the thumb can aggravate this condition. Hobbies and sports that use this motion include:
- Lifting young children.
- Gardening.
- Racquet sports (tennis, racquetball).
- Skiing.
- Using a hammer.
Often, the exact cause of de Quervain’s tendinosis is unknown.
What are the symptoms of de Quervain’s tendinosis?
Symptoms of de Quervain’s tendinosis can include:
- Pain and tenderness along the side of the wrist on the thumb side.
- Pain that gets worse as you use the hand and thumb.
- Pain that appears suddenly or develops over time.
- Pain that travels into the thumb or from the wrist to the lower arm (forearm).
- Pain or difficulty when moving the thumb, especially when grasping or pinching objects.
- Feeling snapping or popping sensation in the wrist when moving the thumb.
Diagnosis and Tests
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.
Management and Treatment
How is de Quervain’s tendinosis treated?
De Quervain’s tendinosis may be treated with non-surgical methods that help manage painful symptoms or with surgery.
Non-surgical treatments
Your healthcare provider may start with non-surgical treatments to improve your symptoms. These non-surgical treatments can 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 four to six weeks.
- Applying ice to your 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.
Surgical treatments
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 typically done under local anesthesia or with mild sedation. 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.
Prevention
Can de Quervain’s tendinosis be prevented?
After treatment, de Quervain’s tendinosis can be prevented by changing the activities that cause pain. Taking breaks and avoiding the actions that cause pain, can help lessen the chance of the condition happening again after treatment. It is important to follow your doctor’s advice on what activities aggravate the condition and what you should avoid. Limiting these activities could prevent future issues with de Quervain’s tendinosis.
Outlook / Prognosis
What is the outlook for de Quervain’s tendinosis?
De Quervain’s tendinosis usually responds very well to treatment. Many people do not need surgery. Treatment with braces, anti-inflammatory medications and rest often corrects the condition. Cases that require surgery have a high success rate. However, de Quervain’s tendinosis does need to be treated. If it is not treated, the condition will continue to become more severe over time.
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