de Quervain’s Tenosynovitis

What is it? de Quervain’s tenosynovitis refers to inflammation of the soft tissues surrounding the tendons that move the thumb – it is an overuse injury. de Quervain’s tenosynovitis affects two thumb tendons. These tendons are responsible for extending the thumb backwards and for moving the thumb away from the palm of the hand. These tendons connect their respective muscles in the forearm to the thumb. On their way to the thumb, the tendons slide through a thick fibrous sheath that forms a tunnel. Normally the tendons glide easily back and forth within this tunnel but in de Quervain’s tenosynovitis the tunnel is tight and irritates the tendons. See figure 1.

Figure 1 What are the symptoms? How did I get it? What should I do? de Quervain’s tenosynovitis results Repetitive or unaccustomed use of Left untreated, this friction-induced in pain and tenderness over the the thumb that involves pinching tenosynovitis can progress to fibrosis thumb tendons as they cross the top with the thumb while moving the and lack of flexibility of the thumb. wrist (e.g., gripping and grasping) of the wrist joint. Here the tendons It generally does not get better leads to thickening of the fibrous may also be swollen. Pinch grasping without medical intervention. tendon sheath. Thickening results in and when the thumb and wrist are You should avoid activities which inflammation and tightening as the moved causes pain. Crepitus or aggravate or provoke your pain. tendon sheath passes over the wrist creaking of the tendons may also be These may lead to further rubbing of bone. de Quervain’s tenosynovitis felt or heard. the tendons and their surrounding is the most common entrapment tissues against the bone, aggravating tendonitis of hand and wrist after the pain and resulting in a prolonged trigger finger. It is most commonly recovery. If you have or suspect that seen in women between 30 and you have de Quervain’s tenosynovitis, 50 years of age. Mothers caring for How is a you shouldn’t ignore the problem. infants aged 6 to 12 months may This can lead to your injury getting diagnosis made? be affected and symptoms are worse which may prolong your often noted in both wrists. Day Care The diagnosis of de Quervain’s recovery. tenosynovitis is suggested by the workers and other persons who characteristic nature of wrist pain repetitively lift infants are frequently and physical examination findings. affected as well. de Quervain’s Sometimes X-Rays, ultrasounds tenosynovitis can also develop after or other scans may be ordered to direct trauma to the area. eliminate any other causes of pain.

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What does rehab Persistent symptoms involve? If symptoms persist it is often necessary to treat the condition The goals of treatment of de more aggressively. Quervain’s tenosynovitis are to reduce inflammation in the Cortisone injection: A local intra- tenosynovial sac, to prevent the lesional glucocorticoid injection formation of adhesions and to into the sheath may be considered prevent recurrent tendinitis. This necessary if pain or swelling is normally involves exercises and persistent for two to six weeks altering lifting and grasping actions. despite the above measures. See figure 3. The injection may be Acute therapy: Therapy in the repeated at four to six weeks if acute setting consists of pain relief symptoms are not reduced by and restriction of thumb gripping 50 percent. Up to 90 percent of and grasping. Pain relief can be Figure 2 patients treated within six months accomplished with ice applications of developing symptoms have relief to the area of pain for 15 minute of pain following glucocorticoid periods every four to six hours. injection. Complications are rare, and Nonsteroidal anti-inflammatory most can resume normal activities drugs may also be helpful if within three weeks (often within the symptoms are recent and are not first week). Approximately 50 to 60 severe. percent of patients have complete Splinting: In severe cases splinting resolution of symptoms with a single of the thumb helps alleviate injection, 30 to 40 percent have symptoms quite dramatically. complete resolution after a second injection, and 10 percent fail to Gentle passive stretching may help Figure 3 respond and require surgery. Patients with symptoms and restore the who have had symptoms for longer ability of the tendon to glide in the than six months prior to treatment sheath. See figure 2. are at risk of fibrosis and have lower success rates. Referral and surgery: surgical consultation is indicated if symptoms are recurrent or persist after two injections within one year.

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