Description

De Quervain's tenosynovitis (ihl-kwer-VAIN ten-oh-sine-oh-VIE-tis) is a painful condition that affects the tendons on the thumb side of the wrist. If you have de Quervain's tenosynovitis, you will probably feel pain when you turn your wrist, grasp anything or make a fist.

Although the exact cause of de Quervain's tenosynovitis isn't known, any activity that relies on repetitive hand or wrist movement — such as working in the garden, playing golf or racket sports, or lifting the arrival of a baby can make it worse.

Symptoms

The symptoms of de Quervain's tenosynovitis include:

  • Pain near the base of the thumb
  • Swelling near the base of the thumb
  • Inability to move the thumb and wrist when doing something that involves grabbing, or pinching
  • A "sticking" or "stop-and-go" sensation in the thumb when you move

If the condition goes too long without treatment, the pain may spread in the thumb or the forearm, or both. By moving the thumb and wrist can make the pain worse.

When to see a doctor

Consult your health care provider if you are still having problems with pain or function, and that I have already tried:

  • Not using your thumb
  • The application of cold to the affected area
  • The use of nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve)

Causes

De Quervain's tenosynovitis affects the two tendons on the thumb side of the wrist. The tendons are ropelike structures that attach muscle to bone.

Chronic excessive use, such as the repetition of a particular movement of the hand, day after day, it can irritate the lining around the tendons. If the cover is irritated, the tendons can thicken and swell. This thickening and inflammation of restricting the movement of the tendons through a small tunnel that connects to the base of the thumb.

Other causes of de Quervain's tenosynovitis include:

  • Inflammatory arthritis, such as rheumatoid arthritis.
  • Direct injury to the wrist or tendon, which can cause scar tissue that restricts the movement of the tendons
  • The retention of fluids, such as changes in hormones during pregnancy

Risk factors

The risk factors for de Quervain's tenosynovitis include:

  • Age. People between the ages of 30 and 50 years have a higher risk of developing de Quervain's tenosynovitis that the people of other age groups, including children.
  • Sex. The condition is most common in women.
  • The fact of being pregnant. The condition may be associated with the pregnancy.
  • The care of the baby. Raising a child repeatedly involves the use of the thumb as a lever, and can be associated with the disease.
  • Jobs or hobbies that involve repetitive hand and wrist movements. These can contribute to the de Quervain's tenosynovitis.

Complications

When the de Quervain's tenosynovitis is treated, it can become difficult for the use of the hand and wrist correctly. The wrist may lose some range of motion.

Diagnosis

To diagnose de Quervain's tenosynovitis, your health care provider will examine your hand to see if you feel pain when pressure is applied on the thumb side of the wrist.

Tests

You may be asked to perform a Finkelstein test, in which bends the thumb in the palm of your hand and bend your fingers down over your thumb. Then, bend the wrist towards the little finger. If this causes pain on the thumb side of the wrist, it's very likely that you have de Quervain's tenosynovitis.

Imaging tests, such as X-rays, are usually not needed to diagnose de Quervain's tenosynovitis.

Treatment

The treatment of de Quervain's tenosynovitis is directed to the reduction of the inflammation, the preservation movement in the thumb and the prevention of the recurrence.

If you start treatment early, your symptoms should improve within 4 to 6 weeks. If the de Quervain's tenosynovitis is initiated during pregnancy, symptoms are likely to end around the end of pregnancy or breastfeeding.

Drugs

To reduce pain and inflammation, your doctor may recommend the use of pain medication that you can buy without a prescription. These include ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve).

Your doctor may also recommend injections of corticosteroids into the tendon of coverage to reduce the swelling. If treatment begins within the first six months of symptoms, most people recover fully after receiving injections of corticosteroids, often after a single injection.

Therapies

The initial treatment of de Quervain's tenosynovitis may include:

  • The immobilization of the thumb and the wrist, keep them straight with a splint or a brace to help the rest of the tendons
  • Avoid repetitive movements of the thumb as much as possible
  • Avoid pinch with the thumb to move your wrist from side to side
  • The application of ice to the affected area

You can also see a physical therapist or an occupational therapist. The therapist can review how you use your wrist and give suggestions on how to relieve the stress on the wrists. Your therapist can also teach you exercises for the wrist, hand, and arm. These exercises can strengthen the muscles, reduce pain and limit the irritation of the tendons.

Surgery or other procedures

Surgery may be recommended for the more severe cases. The surgery is outpatient. In the procedure, the surgeon inspects the sheath that surrounds the tendon or tendons, and then opens the sheath to release the pressure. This allows the tendons to glide freely.

Your health care provider will talk with you about how to rest, strengthen and rehabilitate your body after the surgery. A physical therapist or an occupational therapist may meet with you after the surgery to teach the new strengthening exercises, and help you adjust your daily routine to avoid problems in the future.

Lifestyle and home remedies

If you don't need the surgery, the care of your condition is the same as the prevention of:

  • To avoid the movement of the wrists in the same way on several occasions.
  • Use a brace or a splint if suggested by your health care provider.
  • Follow with recommended exercises.
  • Note of the activity that causes pain, swelling, or numbness in the thumb and the wrist. Try to avoid this activity and share the information with your provider.

Preparing for your appointment

Make an appointment with your health care provider if you have hand or wrist pain, and if you avoid activities that trigger the pain are not helping. After an initial examination, you may be referred to an orthopedist, rheumatologist, a hand therapist or an occupational therapist.

Here's some information to help you prepare for your appointment.

What you can do

  • Make a note of the key medical information, including other conditions you have and all medications and supplements you are taking.
  • Note hobbies and activities that you can force your hand or wrist, such as knitting, gardening, playing an instrument, participating in racquet sports, or performing repetitive activities of the place of work.
  • Note any recent injuries to your hand or wrist.
  • Write questions to ask their doctor.

Below are some basic questions to ask the health care provider who evaluates you by the wrist or hand of related symptoms.

  • What is the most likely cause of my symptoms?
  • There are other possible causes?
  • I need to have tests to confirm the diagnosis?
  • What treatment do you recommend it?
  • I have other health problems. How can I best manage these conditions?
  • I'm going to need surgery?
  • How much time do I need to avoid the activities that caused my condition?
  • What else can I do on my own to improve my condition?

Do not hesitate to ask other questions as well.

What to expect from your doctor

A health care provider who sees you for the common symptoms of de Quervain's tenosynovitis can ask a series of questions. You can ask:

  • What are the symptoms and when they started?
  • The symptoms gradually been getting worse, or staying the same?
  • What activities seem to trigger your symptoms?
  • Do you participate in any hobbies or sports that involve repetitive hand or wrist movements?
  • What tasks are performed on the job?
  • You have recently had an injury that may have damaged your hand or wrist?
  • Helps to avoid the things that trigger your symptoms?
  • Have you tried the at-home treatments, such as non-prescription pain relievers? What, if anything, help?
Symptoms and treatment of De Quervain's tenosynovitis