De Quervain's tenosynovitis — Comprehensive overview of symptoms, treatment of this painful wrist condition.
De Quervain's tenosynovitis (dih-kwer-VAINS ten-oh-sine-oh-VIE-tis) is a painful condition affecting the tendons on the thumb side of your wrist. If you have de Quervain's tenosynovitis, it will probably hurt when you turn your wrist, grasp anything or make a fist.
Although the exact cause of de Quervain's tenosynovitis isn't known, any activity that relies on repetitive hand or wrist movement — such as working in the garden, playing golf or racket sports, or lifting your baby — can make it worse.
Symptoms of de Quervain's tenosynovitis include:
If the condition goes too long without treatment, the pain may spread further into your thumb, back into your forearm or both. Pinching, grasping and other movements of your thumb and wrist aggravate the pain.
Consult your doctor if you're still having problems with pain or function and you've already tried:
Chronic overuse of your wrist is commonly associated with de Quervain's tenosynovitis.
Tendons are rope-like structures that attach muscle to bone. When you grip, grasp, clench, pinch or wring anything in your hand, two tendons in your wrist and lower thumb normally glide smoothly through the small tunnel that connects them to the base of the thumb. Repeating a particular motion day after day may irritate the sheath around the two tendons, causing thickening and swelling that restricts their movement.
Other causes of de Quervain's tenosynovitis include:
Risk factors for de Quervain's tenosynovitis include:
Untreated de Quervain's tenosynovitis might make it hard to use your hand and wrist properly and limit your wrist's range of motion.
To diagnose de Quervain's tenosynovitis, your doctor will examine your hand to see if you feel pain when pressure is applied on the thumb side of the wrist.
Your doctor will also perform a Finkelstein test, in which you bend your thumb across the palm of your hand and bend your fingers down over your thumb. Then you bend your wrist toward your little finger. If this causes pain on the thumb side of your wrist, you likely have de Quervain's tenosynovitis.
Imaging tests, such as X-rays, generally aren't needed to diagnose de Quervain's tenosynovitis.
Treatment for de Quervain's tenosynovitis is aimed at reducing inflammation, preserving movement in the thumb and preventing recurrence.
If you start treatment early, your symptoms should improve within four to six weeks. If your de Quervain's tenosynovitis starts during pregnancy, symptoms are likely to end around the end of either pregnancy or breast-feeding.
To reduce pain and swelling, your doctor may recommend using over-the-counter pain relievers, such as ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve).
Your doctor may also recommend injections of corticosteroid medications into the tendon sheath to reduce swelling. If treatment begins within the first six months of symptoms, most people recover completely after receiving corticosteroid injections, often after just one injection.
Initial treatment of de Quervain's tenosynovitis may include:
You may also see a physical or occupational therapist. These therapists may review how you use your wrist and give suggestions on how to make adjustments to relieve stress on your wrists. Your therapist can also teach you exercises for your wrist, hand and arm to strengthen your muscles, reduce pain and limit tendon irritation.
If your case is more serious, your doctor may recommend outpatient surgery. Surgery involves a procedure in which your doctor inspects the sheath surrounding the involved tendon or tendons, and then opens the sheath to release the pressure so your tendons can glide freely.
Your doctor will talk to you about how to rest, strengthen and rehabilitate your body after surgery. A physical or occupational therapist may meet with you after surgery to teach you new strengthening exercises and help you adjust your daily routine to prevent future problems.
If you don't need surgery, caring for your condition is much the same as preventing it:
Make an appointment with your doctor if you have hand- or wrist-related pain and self-care measures — such as avoiding activities that trigger your pain — aren't helping. After an initial exam, your doctor may refer you to an orthopedist, rheumatologist, hand therapist or occupational therapist.
Here's some information to help you get ready for your appointment.
Below are some basic questions to ask a doctor who evaluates you for wrist- or hand-related symptoms.
Don't hesitate to ask other questions, as well.
Your doctor is likely to ask you a number of questions, including:
July 23rd, 2020