De Quervain’s tenosynovitis is a painful condition that affects the tendons on the thumb side of your wrist. This article dives deep into understanding tenosynovitis, specifically focusing on De Quervain’s tenosynovitis, its symptoms and causes, and the various treatment options available. By the end of this article, you will have a comprehensive understanding of this condition, including its causes, diagnosis, and the best treatments available to manage and relieve the pain associated with it.
Article Outline
- What is Tenosynovitis?
- What Causes De Quervain’s Tenosynovitis?
- Symptoms of De Quervain’s Tenosynovitis
- How is De Quervain’s Tenosynovitis Diagnosed?
- Non-Surgical Treatments for De Quervain’s Tenosynovitis
- Surgical Treatment Options
- Lifestyle Changes to Manage Tenosynovitis
- Exercises to Relieve and Prevent Tenosynovitis
- Role of Medications in Managing Symptoms
- When to Seek Medical Attention
What is Tenosynovitis?
Tenosynovitis is swelling due to inflammation of the sheath surrounding a tendon, usually due to repetitive stress or an underlying condition. This inflammation causes pain, swelling, and difficulty moving the affected tendon.
In the case of De Quervain’s tenosynovitis, the two tendons on the thumb side of the wrist are specifically affected. These are the extensor pollicis brevis and abductor pollicis longus tendons. This leads to pain and swelling, particularly when moving the thumb and wrist. Without treatment, the pain can worsen and affect daily activities.
What Causes De Quervain’s Tenosynovitis?
The exact cause of De Quervain tenosynovitis is unclear, but it often involves repetitive hand and wrist motions. Activities such as lifting a child, gardening, playing sports, or any repetitive use of the hand and wrist can contribute to developing this condition.
In some cases, an injury to the wrist can also lead to tenosynovitis. Swelling causes the tendons and tendon sheath to thicken, which restricts their movement and causes pain. Hormonal changes, such as those during pregnancy, can also make individuals more susceptible to this condition.
Symptoms of De Quervain’s Tenosynovitis
The primary symptoms of De Quervain’s tenosynovitis include pain and swelling at the bottom of the thumb and along the thumb side of the wrist. The pain may be sharp and increase with thumb and wrist motions. You might also notice a “sticking” or “stop-and-go” sensation when moving your thumb.
Other common symptoms include:
- Difficulty moving the thumb and wrist when doing activities that involve grasping or pinching
- Swelling of the thumb or thenar eminence
- A visible lump or nodule at the base of the thumb
- Pain that worsens with activity and eases with rest
How is De Quervain’s Tenosynovitis Diagnosed?
Diagnosing De Quervain’s tenosynovitis typically involves a physical examination. Your doctor may perform a test called the Finkelstein test, where you bend your thumb across the palm of your hand and then cover it with your fingers. You then bend your wrist toward your little finger. If this manoeuvre causes pain along the thumb side of your wrist, it is a positive indicator of the disease.
Imaging tests such as X-rays are usually unnecessary unless there is a suspicion of another underlying condition. The diagnosis is primarily clinical, based on the symptoms and physical examination findings.
Non-Surgical Treatments for De Quervain’s Tenosynovitis
Most patients with De Quervain’s tenosynovitis can be managed with non-surgical treatments. These include:
- Rest and Immobilisation: Avoiding activities that cause pain and using a splint or brace to immobilise the thumb and wrist can help reduce swelling and allow the tendons to heal.
- Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can help reduce pain and inflammation.
- Exercises: The right exercises at the right time in your recovery process can aid the healing process.
- Injections: Corticosteroid injections may provide significant relief by reducing inflammation. A steroid injection relieves the pain and swelling for many patients.
Splinting for De Quervain’s
One of the simplest and most effective treatments for De Quervain’s is the use of a splint. Splinting has been shown to be effective in isolation with early intervention of those with minor symptoms. It has been shown to be most effective when used in combination with corticosteroid injections when symptoms are more severe (1).
Surgical Treatment Options
If symptoms persist despite non-surgical treatments, surgery may be recommended. Surgery is usually reserved for severe cases where other treatments have failed. The procedure involves releasing the sheath covering the tendons to create more room for the tendons to move freely. Where the tenosynovitis affects your ability to make a fist and use the hand and thumb normally, and when you feel pain in the hand or wrist that stops you from doing your normal daily activities and conservative management options have failed, then you might need surgery.
Surgery to treat De Quervain’s tenosynovitis is typically a minor outpatient procedure. Recovery time can vary, but most patients experience significant relief from symptoms and can return to normal activities within a few weeks.
Lifestyle Changes to Manage Tenosynovitis
Making certain lifestyle changes can help manage tenosynovitis and prevent it from recurring. These include:
- Ergonomic Adjustments: Modify your work environment to reduce strain on your hands and wrists.
- Avoid Repetitive Motions: Try to avoid activities that require repetitive hand and wrist motions.
- Proper Technique: Use proper techniques when performing activities that involve your hands and wrists, such as lifting or typing, to reduce the risk of tendon strain.
Exercises to Relieve and Prevent Tenosynovitis
Certain exercises can help relieve symptoms of tenosynovitis and prevent future flare-ups. These exercises focus on stretching and strengthening the tendons and muscles around the thumb and wrist.
Stretching Exercises
- Wrist Stretch: Extend your arm in front of you with your palm facing down. Use your other hand to gently pull your fingers back towards your body, stretching the underside of your wrist. Hold for 15-30 seconds and repeat 2-3 times.
- Thumb Stretch: Hold your hand out, palm up, and use your other hand to gently pull your thumb back towards your wrist until you feel a stretch. Hold for 15-30 seconds and repeat 2-3 times.
Strengthening Exercises
- Thumb Lifts: Place your hand flat on a table with your palm down. Lift your thumb off the table as far as possible without moving your other fingers. Hold for 5 seconds and repeat 10 times.
- Grip Strengthening: Squeeze a soft rubber ball or stress ball, holding the squeeze for 5 seconds. Repeat 10-15 times.
Our Advanced Hand Therapy Team can also teach you exercises tailored to your specific needs and ensure you are performing them correctly.
Role of Medications in Managing Symptoms
Medications play a significant role in managing tenosynovitis symptoms. Over-the-counter NSAIDs, such as ibuprofen and naproxen, are commonly used to reduce pain and swelling. These medications are effective in relieving pain and inflammation, allowing you to continue with daily activities without significant discomfort.
For more severe pain, your doctor may recommend a corticosteroid injection. This injection delivers a powerful anti-inflammatory directly to the site of inflammation, providing quick and effective relief. The site of injection is typically the base of the thumb, where the tendons are inflamed.
When to Seek Medical Attention
It is important to seek medical attention if you experience persistent pain and swelling in your thumb and wrist that does not improve with rest and over-the-counter medications. Early diagnosis and treatment can prevent the condition from worsening and help you return to normal activities more quickly.
You should also consult a healthcare professional if you notice a visible lump or nodule at the base of your thumb, or if your symptoms affect your ability to perform daily tasks. In some cases, untreated tenosynovitis can lead to chronic pain and disability.
Summary
De Quervain’s tenosynovitis is a painful condition affecting the tendons on the thumb side of the wrist. Understanding the causes, symptoms, and treatment options can help you manage and relieve the pain associated with this condition. Here are the key points to remember:
- Tenosynovitis involves inflammation of the sheath surrounding a tendon, causing pain and swelling.
- De Quervain’s tenosynovitis specifically affects the tendons on the thumb side of the wrist, often due to repetitive motions or injury.
- Symptoms include pain, swelling, and difficulty moving the thumb and wrist.
- Diagnosis is typically based on physical examination, including the Finkelstein test.
- Non-surgical treatments include rest, immobilisation, medications, and corticosteroid injections.
- Surgery of the hand may be recommended if symptoms persist despite other treatments.
- Lifestyle changes and exercises can help manage symptoms and prevent recurrence.
- Medications such as NSAIDs and corticosteroid injections play a significant role in symptom relief.
- Seek medical attention if symptoms persist or significantly affect your daily activities.
By understanding and addressing De Quervain’s tenosynovitis, you can take steps to reduce pain, improve function, and maintain an active lifestyle. If you think you may be suffering with De Quervain’s and would like the help of our expert hand therapy team, then get in touch to book your assessment and treatment now.
References:
- Abi-Rafeh, Jad H.B.Sc., M.Sc.; Kazan, Roy M.D., Ph.D.; Safran, Tyler M.D.; Thibaudeau, Stephanie M.D., C.M. Conservative Management of de Quervain Stenosing Tenosynovitis: Review and Presentation of Treatment Algorithm. Plastic and Reconstructive Surgery 146(1):p 105-126, July 2020. | DOI: 10.1097/PRS.0000000000006901
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