DeQuervain's Tenosynovitis

Tendons of the Hand

The muscles and bones of the hand are connected by thick flexible tissue called tendons. Tendons are covered by a thin, soft sheath of tissue known as synovium. Extensor pollicis brevis and abductor pollicis longus are two tendons on the wrist's thumb side.

What is De Quervain’s Tenosynovitis?

Inflammation and swelling of the tendon sheaths put pressure on the adjacent nerves and lead to pain and numbness in the thumb side of the wrist.

The strain on these tendons can cause swelling and irritation and lead to De Quervain's tenosynovitis, which is characterised by inflammation. The condition is also called De Quervain’s tendinitis, De Quervain’s tendinosis, De Quervain’s syndrome, or De Quervain’s disease.

Impact of DeQuervain’s Tenosynovitis on Health

The pain can range from mild to severe and often worsens when you use your thumb to grasp things or twist your wrist. This can limit your ability to perform tasks requiring hand or wrist movement, such as writing, cooking, or lifting objects. If left untreated, the condition can lead to chronic pain, decreased range of motion, and in some cases, permanent impairment of thumb and wrist function.

Causes and Risk Factors for DeQuervain’s Tenosynovitis

The exact cause of DeQuervain's tenosynovitis isn't known, but certain factors increase your risk. These include:

• Women, especially those between 30 and 50, are more likely to develop the condition than men.
• New mothers are at increased risk, possibly because of the inflammation and fluid retention that can occur during pregnancy and the repetitive lifting and holding of a baby after birth.
• Jobs or hobbies that involve repetitive hand or wrist movements, such as gardening, playing certain musical instruments, or work that involves consistent typing, can increase the risk.
• Conditions that lead to chronic inflammation, such as rheumatoid arthritis, can increase the risk of developing DeQuervain's tenosynovitis.
• A direct blow to the side of the wrist or thumb can lead to DeQuervain's tenosynovitis.

Signs and Symptoms of De Quervain’s Tenosynovitis

The primary symptom of DeQuervain's tenosynovitis is pain and tenderness on the thumb side of the wrist. The pain may appear either gradually or suddenly, and it can travel up the forearm. The pain is usually worse with the use of the hand and thumb, especially when forcefully grasping things or twisting the wrist.

Other symptoms may include:

• Swelling over the thumb side of the wrist. A fluid-filled cyst in this area may accompany this.
• Stiffness in the thumb and wrist, particularly in the morning.
• Difficulty moving the thumb and wrist when gripping or pinching due to pain or swelling.
• A "sticking" or "stop-and-go" sensation in your thumb when trying to move it.

Stages of De Quervain’s Tenosynovitis

• Early Stage: In the early stages, a person may experience mild discomfort or pain in the thumb or wrist during certain activities. The pain might be intermittent and easy to overlook or dismiss as general fatigue or strain.
• Progressive Stage: As the condition progresses, pain and swelling may become more noticeable and consistent. The discomfort might spread to the forearm and worsen during or after repetitive thumb or wrist activities.
• Chronic Stage: If left untreated, the condition can become chronic, leading to persistent pain and possible thumb and wrist movement limitations. In some cases, a person might experience a reduced range of motion in the wrist or thumb, and the affected tendons may become permanently thickened or scarred.

Diagnosis of De Quervain’s Tenosynovitis

Diagnosing DeQuervain's tenosynovitis typically involves a physical examination and a review of your symptoms and medical history. Your doctor may perform an Eichhoff test, which involves bending your thumb across the palm of your hand and bending your fingers down over your thumb. Then, you'll bend your wrist towards your little finger. If this manoeuvre causes pain on the thumb side of your wrist, you likely have DeQuervain's tenosynovitis.

Imaging tests like X-rays are not typically necessary to diagnose DeQuervain's tenosynovitis. Still, your doctor might order them if they want to rule out other conditions causing your symptoms, such as arthritis.

Treatment of De Quervain’s Tenosynovitis

Treatment of De Quervain’s syndrome consists of both non-surgical and surgical therapy.

Non-surgical measures include:

• Rest and Immobilisation: Avoiding activities that cause pain and swelling can help the tendons heal. A splint or brace may be used to immobilise the thumb and wrist, giving the tendons a chance to rest and recover.
• Ice: Applying ice to the affected area can help reduce swelling and relieve pain.
• Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Over-the-counter drugs like ibuprofen can help reduce pain and swelling.
• Corticosteroid Injections: If conservative measures are ineffective, your doctor may recommend a corticosteroid injection into the tendon sheath to reduce inflammation and pain.
• Physical Therapy: Exercises may be suggested to strengthen the thumb and wrist, improve the range of motion, and prevent the recurrence of the condition.

Surgery may be recommended in severe cases or when the condition doesn't improve with conservative treatments. The outpatient surgical procedure involves opening or cutting the inflamed part of the tendon sheath to relieve the pressure on the tendon and allow free wrist movement. Your surgeon will also instruct you on exercises to strengthen your wrist.

What if DeQuervain’s Tenosynovitis is Untreated?

DeQuervain's tenosynovitis can lead to chronic pain and limited thumb and wrist movement if left untreated. The inflammation and swelling could cause permanent damage to the tendons or the surrounding sheath, leading to lasting difficulties with hand function. That's why it's important to seek medical attention if you have persistent pain in your thumb or wrist.