DeQuervain’s Tenosynovitis

Dr Jacqueline Tan

Senior Consultant Hand Surgeon

MBBS (SG) | MRCS (Edin) | MMed (Surgery) | FAMS (Hand Surgery)

De Quervain’s tenosynovitis is a condition caused by inflammation of the tendons at the base of the thumb. This inflammation affects the smooth lining of the tendons, called the synovium, leading to pain, swelling, and restricted movement. Normally, the tendons glide effortlessly through small compartments in the wrist, but inflammation makes this movement uncomfortable and difficult.

The condition is often linked to repetitive thumb or wrist movements and can interfere with daily activities such as grasping or rotating the wrist.

Symptoms Causes Diagnosis Treatment Prevention FAQ

Symptoms of DeQuervain’s Tenosynovitis

Individuals with De Quervain’s tenosynovitis often experience symptoms that are aggravated by specific thumb or wrist movements. Common symptoms include:

Pain near the base of the thumb: This pain may extend up the forearm and worsen during activities like pinching or grasping. In advanced cases, even small thumb or wrist movements can cause discomfort.
Swelling on the thumb side of the wrist: Swelling may be visible near the wrist joint, sometimes accompanied by fluid-filled cysts at the base of the thumb.
Difficulty moving the thumb and wrist: Tasks involving thumb motion or gripping can become increasingly difficult and uncomfortable.
Snapping or catching sensation: A clicking or snapping feeling may occur when moving the thumb, often due to tendon restrictions caused by swelling or thickening of the tendon sheath.

Causes and Risk Factors

De Quervain’s tenosynovitis is often caused by repetitive stress or strain on the thumb tendons, with several factors contributing to its development.

Repetitive hand movements: Actions like typing, gardening, or lifting a child using the thumb for leverage can strain the tendons. Overuse may irritate the tendon sheath, leading to thickening and restricted movement.
Direct injury to the wrist or thumb: Trauma, such as a wrist fracture, can increase stress on the tendons or lead to scar tissue formation, which impairs tendon movement.
Inflammatory conditions: Disorders like rheumatoid arthritis can raise the likelihood of developing this condition by affecting tendon health.
Hormonal changes: Pregnancy and breastfeeding are linked to a higher risk, possibly due to hormonal fluctuations affecting tendon and ligament elasticity.

Diagnostic Methods

Observation of symptoms

A physical examination is performed to check for swelling, tenderness, and restricted thumb movement. In some cases, fluid-filled cysts at the base of the thumb may also be visible, further supporting the diagnosis.

Finkelstein test

The patient folds their thumb across the palm and closes the fingers over it, forming a fist. Then, the wrist is tilted towards the little finger. If this movement causes pain near the base of the thumb, it is a strong indicator of De Quervain’s tenosynovitis.

Imaging studies

X-rays or ultrasound scans may be used to exclude other conditions that can cause similar symptoms, such as arthritis, fractures, or other structural abnormalities in the wrist.

Treatment Options

Treatment for De Quervain’s tenosynovitis focuses on relieving pain, reducing inflammation, and improving function. Non-surgical options are usually tried first, with surgical treatments considered for persistent cases.

Non-Surgical Treatment

Rest and Activity Modification

Avoiding repetitive thumb and wrist movements is necessary to reduce strain on the tendons. This can be achieved by altering daily activities or taking breaks during tasks. Rest is often supported by wearing a splint to keep the thumb and wrist immobilised and promote healing.

Splinting

A thumb and wrist splint is used to stabilise the affected area and limit movement, reducing irritation to the inflamed tendons. The splint helps maintain the thumb in a neutral position, allowing the tendons to recover and preventing further strain.

Medications

Non-steroidal anti-inflammatory drugs, such as ibuprofen or naproxen, can help manage pain and swelling. These medications are available over the counter or may be prescribed for short-term use to reduce inflammation.

Corticosteroid Injections

A corticosteroid injection directly into the affected tendon sheath can provide rapid and significant relief from pain and inflammation. In addition to reducing swelling, the injection can help soften the tendon sheath, improving tendon movement and reducing friction in the area.

Surgical Treatment

Tendon Sheath Release

For severe cases or when non-surgical treatments are ineffective, a surgical procedure may be performed to release the tight tendon sheath. This creates more space for the tendons to move freely, reducing pain and improving function. The surgery involves a small incision near the affected area and typically leads to restored movement and relief from symptoms.

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Prevention and Management

To prevent De Quervain’s tenosynovitis, it is helpful to avoid repetitive thumb and wrist movements and take regular breaks during activities that strain the hands. Maintaining an ergonomic wrist position during tasks, especially at work, can minimise stress on the tendons. Simple adjustments to daily routines, such as modifying lifting techniques or using ergonomic tools, can further help to reduce strain on the thumb tendons and prevent irritation.

Frequently Asked Questions

Does De Quervain’s tenosynovitis resolve without treatment?

In mild cases, the condition may gradually improve with sufficient rest and by avoiding activities that aggravate the symptoms. However, most cases benefit significantly from timely medical intervention to ensure full recovery.

Can De Quervain’s tenosynovitis recur after treatment?

Yes, the condition can recur if repetitive strain, improper hand and wrist positioning, or similar activities that caused the initial issue continue, even after successful treatment and recovery.

Can pregnancy-related cases resolve after childbirth?

Yes, in many instances, symptoms naturally improve or resolve after childbirth as hormone levels stabilise and the strain on the thumb tendons from activities like lifting decreases.

Dr Jacqueline Tan

Senior Consultant Hand Surgeon

MBBS (SG)

MRCS (Edin)

MMed (Surgery)

FAMS (Hand Surgery)

Dr. Jacqueline Tan is a hand surgeon in Singapore with over 18 years of experience in managing hand, wrist, and nerve conditions. Formerly the Head of Department of Hand and Reconstructive Microsurgery at Singapore General Hospital, she has continued to contribute significantly to her profession.

Director of Micro-Reconstruction Service and the Director of Peripheral Nerve and Paralytic Upper Limb Service
Upon the completion of her training as a hand surgeon in Singapore, Dr Tan was awarded the prestigious Health Manpower Development Plan scholarship by the Ministry of Health (MOH).
Completed a one-year advanced fellowship in Taiwan under the tutelage of internationally-acclaimed Hand and Orthopedic Microsurgeon – Professor Yuan-Kun Tu
Dr Tan’s field of expertise is in early and late brachial plexus reconstruction, peripheral nerve disorders, reconstructive microsurgery of the extremities and wrist disorders.

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