De Quervain's Tenosynovitis

De Quervain's tenosynovitis causes pain at the base of the thumb.

• De Quervain's tenosynovitis is a painful condition of the wrist caused by inflammation, thickening, or entrapment of the tendon.
• De Quervain's tenosynovitis may result from overuse or repetitive movements of the wrist.
• The diagnosis of de Quervain's tenosynovitis can be made on during physical examination by a health care provider.
• De Quervain's tenosynovitis may resolve on its own. Other treatments include anti-inflammatory medications and steroid injection. Rarely, surgery is necessary.

Thickening or inflammation of the tendons that move the thumb causes de Quervain's tenosynovitis. This thickening causes the tendons to become entrapped, or rub, as they pass by the wrist bone to attach to the thumb. This condition is also known as a radial styloid tenosynovitis. De Quervain's tenosynovitis is named after the Swiss surgeon, Fritz de Quervain, who first described it in 1895. This is similar to tendinitis, but medical professionals consider it to be slightly different than tendinitis because of thickening of the tendon sheath.

De Quervain's tenosynovitis is associated with repetitive wrist motion, especially movements that involve extending the thumb while turning the wrist. It frequently occurs in new mothers and may be related to lifting the child. The overuse causes inflammation and thickening of the tendons, which may lead them to become entrapped and push on the fibrous tunnel they travel through. This causes pain. Trauma and injury to the wrist can also cause traumatic de Quervain's tenosynovitis.

The main symptom of de Quervain's tenosynovitis is wrist pain. The pain is located at the base of the thumb and may extend up the side of the forearm. The pain is usually worse with movement of the thumb and wrist. The pain can be worse with tasks such as opening a jar lid. The symptoms are usually on one side but can be on both sides, especially in new mothers and child care workers. The pain can be associated with tenderness at the location and sometimes swelling.

De Quervain's tenosynovitis is a clinical diagnosis. This means that a health care provider diagnoses it on the basis of the symptoms and physical examination of the patient. Doctors often perform a test known as the Finkelstein test as an examination maneuver. In this test, the thumb is flexed and held inside the fist while the patient bends the hand away from the body. When de Quervain's tenosynovitis is present, this maneuver causes sharp pain along the wrist near the base of the thumb. The Finkelstein maneuver is very helpful in diagnosis. X-rays are not helpful in confirming the diagnosis but may exclude other causes of wrist and thumb pain, such as osteoarthritis at the base of the thumb.

De Quervain's tenosynovitis may resolve without any treatment. The first step is to try and reduce stress on the area by decreasing repetitive wrist motion and not reinjuring the wrist. If symptoms persist, splinting and taking systemic nonsteroidal anti-inflammatory medications such as naproxen sodium (Naprosyn), diclofenac sodium (Voltaren), and others may be helpful. Local corticosteroid injections are often helpful. The initial injection may relieve symptoms in 50% of patients, with a second injection providing relief and another 40%-45%. Splinting with a thumb spica brace may offer temporary relief, but recurrence of symptoms after the splint is removed is common. Infrequently, a doctor can perform surgery if symptoms fail to improve or recur. Surgery has a high rate of symptomatic relief and low rate of complications.

As overuse is a risk factor for this condition, avoid exuberant exercises to treat it.

The main complication of de Quervain's tenosynovitis is pain. Most patients have relief of symptoms with splinting, use of systemic nonsteroidal anti-inflammatory medications, getting local corticosteroid injections, or having surgery. It is possible for the condition to become chronic if the overuse contributing to the condition is not altered or if the condition is not treated.

The prognosis for de Quervain's tenosynovitis is good. Symptoms generally respond to appropriate treatment. If the initial treatment is ineffective, surgery has a high rate of symptom relief.

It may be possible to prevent de Quervain's tenosynovitis with attention to body mechanics and avoiding overuse of the wrists.