De Quervain'S Tenosynovitis

1 What is De Quervain's Tenosynovitis?

De Quervain's tenosynovitis is a condition whose main characteristic is pain located in the tendons on the thumb side of the wrist.

The pain mostly intensifies when you make a fist or grasp for something. The cause of this condition is yet to be found.

Any activity which is characterized by repetitive movement of the hands or wrists, may worsen the condition.

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2 Symptoms

Main symptoms of De Quervain's tenosynovitis are:

  • Pain at the radial side of the wrist
  • Swelling at the base of the thumb
  • Difficulty gripping with the affected place
  • Spasms
  • Burning sensation in your wrist

If not treated, the condition tends to spread through the thumb and forearm.

The pain is mostly provoked by pinching, grasping, or similar movements of the wrist.

3 Causes

Despite the fact that the underlying cause of De Quervain's tenosynovitis is still unknown, it has been noticed that chronic overuse of the wrist is associated with it. At a certain moment, this overuse begins to irritate the sheath that overlays tendons in your wrist.

In normal conditions, these tendons glide through a tunnel that leads them to the base of the thumb. When it gets heavily irritated , this sheath begins to thicken and swell, which shrinks the space which is predetermined for tendon movement. Afterwards, the movement gets restricted and symptoms start to emerge.

Other causes include: scar tissue, other types of inflammation, arthritis, injury, pregnancy, hormonal changes etc.

4 Making a Diagnosis

In order to diagnose de Quervain's tenosynovitis, your doctor will examine your hand.

In case that ordinary measures, such as rest and avoiding movements that trigger the pain, don’t help,talk to your doctor.

Your doctor may refer you to the specialist ( rheumatologist, orthopedic). Do not forget to mention other conditions that you have, medications that you take, previous injuries, your occupational activities etc.

Examination techniques include physical examination ( including Finkelstein test) and perhaps an X-ray.

5 Treatment

The main focus of the treatment for de Quervain's tenosynovitis is reduction of inflammation, and preservation of the thumb movement .

The earlier you start treatment , the better the result is. If you start early, you should expect improvement within four to six weeks.

For the pain, your doctor may suggest you use pain relievers, such as ibuprofen or naproxen. For inflammation and swelling, you may be recommended to use injection of corticosteriods.

Non-medication therapy includes:

  • Immobilization
  • Avoiding of trigger movements
  • Cryotherapy
  • Physical therapy
  • Cold laser treatment

So far, surgical procedure that involves longitudinal opening of the swollen tendon sheath, has proved to be the most beneficial. It eliminates the pressure on the tendons and causes relief in majority of patients.

6 Lifestyle and Coping

Lifestyle modifications are necessary in order to cope with De Quervain's tenosynovitis.

Follow the advice of your doctor.

Avoid movements that trigger pain and irritation.

Use immobilization techniques and rest your wrist.

Follow through with recommended exercises.

7 Risks and Complications

You are under increased risk of developing de Quervain's tenosynovitis if you are:

  • Aged between 30 and 50
  • Female
  • Pregnant
  • Repeatedly moving your thumbs and wrist on your workplace