DeQuervain’s Tenosynovitis is an inflammatory condition of the wrist tendons at the base of the thumb. This condition causes pain at the thumb area that is closest to the wrist. The tendons of the wrist and fingers run through isolated compartments at the level of the wrist. In a healthy hand, these tendons of the thumb are able to glide through these compartments easily when the finger moves, because of a soft, smooth tissue layer known as the synovium. When the lining of the synovium becomes inflamed, it results in pain over wrist area near the thumb wrist and movements of the thumb are often painful.
The most common cause of DeQuervain’s tenosynovitis is chronic overuse of the wrist. Repetitive movements such as lifting or carrying a child and leveraging the weight on your thumbs, may cause irritation to the sheath around the tendons, resulting in thickening and swelling around the area. Over time, this leads to restrictions in movements. A direct injury to the wrist such as a wrist fracture may increase the risk of DeQuervain’s tenosynovitis because of the increased stress across the tendons.
Signs And Symptoms
Pain is the most commonly reported symptom associated with DeQuervain’s tenosynovitis. Activities that require pinching, tight gripping, wrist rotation may trigger the pain. In more severe cases, pain may be present even with the slightest movements of the thumb and wrist. Aside from the pain, swelling of the wrist area near the thumb can be observed and fluid-filled cysts can be noticed at the base of the thumb. Some patients may experience a snapping sensation when they move their thumbs.
Before diagnosing you with DeQuervain’s tenosynovitis, doctors may do a simple test known as Finklestein maneuver. Patients are asked to fold their thumb across the palm before making a fist with the fingers clasped over the thumb. The patient is then asked to bend the wrist towards the little finger. If pain is experienced during the test, then the patient is most likely suffering from DeQuervain’s tenosynovitis. Sometimes, x-rays may also be needed to rule out other conditions such as arthritis or fractures.
The treatment focus for DeQuervain’s tenosynovitis is on reducing pain and swelling. Doctors may recommend resting the thumb and wrist by wearing a splint and avoiding activities that require repetitive hand and wrist motions. Non-steroidal anti-inflammatory drugs (NSAIDS) may also be prescribed by the doctor to reduce pain and swelling.
A steroid injection may also be given to help reduce pain and swelling in the tendon or surrounding tissue. In the case of DeQuervain’s tenosynovitis, the steroid injection not only helps to reduce inflammation, but also softens the tendon sheath and improves tendon movement.
Surgery is only recommended if your case is severe or if the other conservative treatments do not relieve the pain. During the surgery, the surgeon will make a small cut in the sheath around the swollen tendons, providing more room for the inflamed tendons to move. After surgery, patients can attempt to resume normal use of their hand once comfort and strength have returned.
Every case is different, hence it is best to consult a hand surgeon to determine the treatment method that is most suitable for you. Reach out to us today if you are suffering from DeQuervain’s tenosynovitis and let us help you.