De Quervain’s Tenosynovitis
De Quervain’s Tenosynovitis is a term used to describe a painful condition in the base of the thumb and wrist joint. The main tendon in the thumb which aides in motion such as giving a “thumbs up” can get swollen or hypertrophy causing increased pressure on the protective sheath encapsulating these tendons. If swelling is present, this could be due to inflammation which can cause significant and debilitating pain. The repetitive nature of making motions like creating a fist, using a hammer, picking up a small child, or gardening usually stress the tendons in the thumb exacerbating the symptoms and causing more pain.
Signs of De Quervain’s include: swelling of the wrist, pain, limited range of motion, “catching” or “snapping” sensation when moving the thumb, or a fluid filled cyst over the base of the thumb. To test the area for De Quervain’s , fold the thumb across the palm and flex the fingers over the thumb; then, flex the hand down toward the little finger away from the involved wrist area. If there is increased pain, this is a positive (Finkelstein’s) sign of possible De Quervain’s tenosynovitis. It is important to be evaluated by a medical professional if there is an indication of a positive test so treatment can begin as soon as possible.
Treatment options include: splinting the wrist and immobilizing it in a brace to prevent increased tension on the tendons, use of NSAIDs or corticosteroid injections to aide in reducing inflammation, physical therapy to reduce pain and inflammation by massage, stretching, ultrasound or electrical stimulation. If all avenues of treatment have been exhausted, sometimes surgery is indicated; in this case, a surgeon will decompress the tendons by cutting the protective sheath relieving the pressure and reducing the pain.
Regardless of treatment, the most effective way to reduce pain is to stop the repetitive motions initially causing the pain and immobilizing the joint so the hypertrophied tendons can reduce in size. This is very challenging for some individuals whose livelihood depends on using their hands; however, once the pain has subsided, and strength has returned, normal activity can resume.