Anatomy & Cause
Tendons are long cord-like structures that attach muscle to bone. There are two tendons that connect the wrist to the thumb. They pass through a tunnel called a tendon sheath, which allows them to glide smoothly as the thumb bends and straightens.
Chronic overuse of the wrist and thumb due to repetitive movements can lead to thickening, swelling and inflammation of the tendons and tendon sheath, which results in increased friction between the structures. This translates to intense pain when moving the wrist, or when using the thumb to grasp or pinch.
Signs and Symptoms
What are the Signs and Symptoms of De Quervain’s Tenosynovitis?
- The main symptom is pain felt over the thumb side of the wrist and can spread upwards to the forearm. The pain tends to develop slowly over time and is typically increased with thumb movements involving grasping or pinching, or on wrist rotation.
- Swelling over the thumb side of the wrist. Sometimes a fluid-filled cyst may be seen
- Difficulty moving the thumb and wrist
- A catching or snapping sensation in the thumb when moving it
What are the Risk Factors for De Quervain’s Tenosynovitis?
The risk factors for De Quervain’s Tenosynovitis include:
- People whose occupations or hobbies involve chronic overuse of the wrist and having to repeatedly grasp or pinch with the thumb
- Previous injury to the wrist or base of the thumb resulting in a buildup of scar tissue
- Tends to occur between the ages of 30 to 50
- More common in women than in men
- Certain medical conditions such as pregnancy and rheumatoid arthritis
How to Diagnosis De Quervain’s Tenosynovitis?
De Quervain’s Tenosynovitis can be diagnosed by your doctor after a detailed history and physical examination of the wrist and affected thumb. Usually, no investigations or X-rays are required.
What are the Treatment available for De Quervain’s Tenosynovitis?
The treatment for De Quervain’s Tenosynovitis depends on the severity and include:
- Avoidance of the causative activity
- Painkillers such as paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs)
- Gentle exercises to strengthen the muscles, relieve the pain and reduce irritation to the tendon
- Wearing a splint to immobilize the wrist and thumb
- Extracorporeal Shockwave Therapy (ESWT). This is a painless and non-invasive procedure which causes improvement in blood circulation and a tissue-repairing effect on the inflamed tendons
- Corticosteroid (H&L) injection. This is injected into and around the tendon sheath, and reduces the inflammation. The effect may be temporary, usually around 3 months, but may sometimes last a year or longer. More than one injection may be necessary.
- If all else fails, surgery can be considered. The procedure involves releasing the tendon to allow it to glide freely, and is usually performed under local anaesthesia.