De Quervain Tenosynovitis
De Quervain tenosynovitis, also known as radial styloid tenosynovitis or de Quervain syndrome, is a form of tendinitis characterised by the inflammation of the tendons and tendon sheath located on the thumb side of the wrist, resulting in a sudden or gradual onset pain that may intensify over time.
Causes and Risk Factors
De Quervain syndrome is common in individuals who overuse their thumb and wrist. Those at risk of developing this condition often engage in physically demanding jobs or activities that require frequent and repetitive thumb and wrist movement. Other factors that may result in a higher risk of developing this form of tendinitis include:
- Past injuries to the wrist area
- Old age (Individuals aged 40 years and over are more likely to develop this condition)
- Arthritis (Joint inflammation)
Recurring and frequent strain to the tendons in the wrist when performing activities that are not traditionally considered physically strenuous can likewise result in tendinitis. De Quervain tenosynovitis can be caused by common everyday activities and hobbies such as:
- Texting on a mobile phone – Known as “texter’s thumb” or “texting thumb”
- Washing dishes – Known as “washerwoman’s sprain”
- Playing video games – Awkward and erratic movement of the thumb when using a video game controller can result in “gamer’s thumb”
- Frequent holding/handling of a baby – “Mommy thumb” is prevalent in women 8 months postpartum
De Quervain syndrome in women
Women are more likely to be affected by De Quervain tenosynovitis compared to men; with pregnant and lactating women having the highest risk of developing this condition.
“Mommy thumb”, “mother’s thumb”, or “baby wrist” are names often used to describe a mild to intense pain felt at the base of the thumb experienced by new mothers. The main causes of this condition are:
- Hormonal changes – Pregnant and/or breastfeeding women often experience fluid accumulation, particularly in the wrists and hands, due to an increase in the production of fluid retention hormones by the body.
Saturation of the tendon sheath with fluids results in the swelling of the sheath and thus increases the likelihood of developing de Quervain’s tenosynovitis.
- Repetitive action – Postpartum de Quervain’s tenosynovitis is frequently reported by mothers due to prolonged and frequent stress being placed on the wrist when supporting the weight of their child during breastfeeding or bonding.
Repetitive rubbing of the wrist tendon against its sheath when holding the child increases the risk of tendon inflammation/swelling and hence, the risk of de Quervain’s tenosynovitis.
Signs And Symptoms Of De Quervain Tenosynovitis
Tenderness of the wrist or pain near the base of the thumb are the main symptoms of de Quervain tenosynovitis. Additionally, noticeable swelling over the thumb side of the wrist/at base of the thumb can sometimes be observed and the swelling can be accompanied by fluid-filled cyst.
Patients who suffer from de Quervain syndrome often experience difficulty moving their thumbs to perform pinching or grasping actions; performing said actions or just moving the thumb can also cause a sharp pain or intensify the chronic pain already experienced by the patient.
If left untreated, de Quervain tenosynovitis has the potential to worsen and spread upwards into the forearm. Over time, the patient may lose mobility and range of wrist motion, and find it increasingly difficult to move their wrist, hand, and/or thumb.
Wrist pain can be the result of a wide range of issues; for example, tenderness of the wrist can be caused by inflamed tendons (de Quervain tenosynovitis) or the compression of a nerve (carpal tunnel syndrome). While the root cause of both conditions (de Quervain tenosynovitis and carpal tunnel syndrome) is the over exertion of the wrist, it can be hard to pinpoint the part of the wrist that is affected (tendon or nerve) if you are not a trained medical professional.
A doctor or aesthetic clinic should be contacted if the following symptoms are experience to prevent misdiagnosis:
- Tenderness or pain (aching or sharp) at the base of the thumb or wrist
- Swelling at the thumb side of the wrist or at base of the thumb
- Numbness of the thumb and index finger
- Difficulty moving the wrist and/or thumb
- A “snapping” or “popping” sensation felt moving the thumb
To determine if the patient is suffering from de Quervain syndrome, the doctor may perform a physical examination to check for inflammation of the tendon. A Finklestein’s test, X-ray, ultrasound, and blood test may also be performed to rule out other possible causes of pain/discomfort such as arthritis.
Finklestein test, also know as a Eichhoff test, is a non-invasive physical examination where the doctor will ask the patient to place their thumb in their palm and grasp it using their other fingers while bending the wrist in the direction of their little finger. The doctor will then observe for signs of strain or inflammation of the tendon, the patient would be considered positive for the Finklestein test should they experience pain when bending the wrist or if the doctor observes problems with their tendon.
X-ray and ultrasound
De Quervain syndrome can be immediately diagnosed if a visible thickening and/or swelling of the tendons at the base of the thumb is observed during an X-ray and/or ultrasound.
De Quervain syndrome can be treated non-surgically or surgically depending on the severity of the patient’s condition as diagnosed by a doctor. Non-surgical treatment generally involves alleviating or reducing the swelling and irritation to the tendons and tendon sheath, while surgical treatment works by surgically making more room for the irritated tendons to allow them to move more freely.
If detected early, mild de Quervain tenosynovitis can be treated using mechanical methods or a lifestyle change.
- Splints – A removeable splint may be worn to rest and keep the wrist straight while keeping the thumb in a comfortable position to allow for the tendons to heal. The splint may be worn during the day or at night to provide relieve to the tendons and tendon sheath to alleviate pain/discomfort.
- Lifestyle change – For mild cases of de Quervain tenosynovitis, a change in activity level (for example, reducing the time spent on a hobby) can be enough for the symptoms to resolve on their own without any further medical intervention.
For more severe cases of de Quervain tenosynovitis where the patient experiences greater discomfort/pain, the doctor may prescribe anti-inflammatory drugs or corticosteroids to reduce the swelling of the tendons and tendon sheath.
- Anti-inflammatory drugs – Non-steroidal anti-inflammatory drugs (NSAIDs) can be taken orally or applied topically to the affected area to relieve inflammation. NSAID such as ibuprofen, naproxen, arcoxia, or diclofenac work by inhibiting the activity of enzymes that synthesise biological mediators involved in inflammation to reduce swelling and alleviate pain.
- Corticosteroids – Corticosteroids can be administered via an injection into the tendon sheath (the tunnel housing the tendons) to effectively reduce swelling. The steroid softens and loosens the tendon sheath, reversing the inflammation and easing the pain felt by the patient.
If the patient is unresponsive to non-surgical treatment, or if non-surgical treatments do not provide adequate pain relief, de Quervain tendinitis surgery can be considered.
In patients diagnosed with de Quervain syndrome, the tendon sheath is often thickened; narrowing it, and restricting the movement of the tendons leading to friction when the tendons move, and thus inflammation and pain. De Quervain tendinitis surgery involves releasing the tendon sheath to free the tenons and make more room for them to reduce friction when moving the wrist.
De Quervain tendinitis surgery is a relatively quick procedure that can be performed under local anaesthesia. During the surgery, the doctor will make a small incision on the thumb side of the wrist, the tendon sheath is then cut open, and the incision is then stitched up.
As this is a minimally invasive surgery the wound is expected to heal within a week, and wrist and thumb movement should return to normal after a month or a month and a half.
De Quervain tendinitis surgery is a permanent solution for treating de Quervain syndrome. Patients who experience recurring tendinitis even after recovering from past instances of de Quervain tenosynovitis following receiving non-surgical treatment may be good candidates for de Quervain tendinitis surgery.