DE QUERVAIN’S TENDINOSIS

OVERVIEW

De Quervain’s tendinosis is a painful swelling (inflammation) of the tendons of the thumb. 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 causes friction. The tendons can no longer easily slide through their sheaths. When this happens, certain thumb and wrist motions become more difficult to do.

Causes

The exact cause of de Quervain’s tendinosis is unknown. However, it can be triggered by several factors as follows:

1. Overuse.
2. A direct blow to the thumb.
3. Repetitive grasping.
4. Inflammatory conditions (including arthritis)
5. Women 8 to 10 times more often affected than men.

Diagnosis and Symptoms

1. Pain and tenderness along the side of the wrist on the thumb side.
2. Pain that gets worse as the hand and thumb is used as in grasping, pinching the objects.
3. Pain may travel into the thumb or from the wrist to the lower arm (forearm)
4. Feeling snapping or popping sensation in the wrist when moving the thumb.
5. Activities that require a sidewise motion of the wrist while you are gripping with the thumb can aggravate this condition. E.g. Lifting young children, gardening, racquet sports (tennis, racquetball), using a hammer, household activities like cooking, cleaning the floor, cleaning cloths.
6. 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 sideways; the motion of shaking someone’s hand. This movement is painful in de Quervain’s tendinosis.

Treatment and Prevention

De Quervain’s tendinosis can be treated with non-surgical methods that help manage painful symptoms or with surgery.

Non-surgical treatments include:

1. 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.
2. Applying ice to your thumb and wrist area to reduce swelling.
3. Lifestyle modification: Avoiding activities that are causing pain and swelling.
4. Medications: If symptoms continue, your doctor may give you anti-inflammatory medication, such as naproxen or ibuprofen, to decrease pain and swelling.
5. Steroid injection into the tendon sheath can also decrease pain and swelling
6. Physiotherapy

Surgical treatment is offered if nonsurgical treatment does not work.

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.