What is it?

De Quervain's tenosynovitis occurs when the tendons around the base of the thumb are irritated or constricted. The word "tendinosis" refers to a swelling of the tendons. Swelling of the tendons, and the tendon sheath, can cause pain and tenderness along the thumb side of the wrist. This is particularly noticeable when forming a fist, grasping or gripping something, or when turning the wrist.

Anatomy

Two of the main tendons to the thumb pass through a tunnel (or series of pulleys) located on the thumb side of the wrist. Tendons are rope-like structures that attach muscle to bone. Tendons are covered by a slippery thin soft-tissue layer, called synovium. This layer allows the tendons to slide easily through a fibrous tunnel called a sheath.

Any swelling of the tendons and/or thickening of the sheath, results in increased friction and pain with certain thumb and wrist movements.

Mechanism of Injury

De Quervain's tendinosis may be caused by overuse. It also is associated with pregnancy and rheumatoid disease. It is most common in middle-aged women.

Signs of De Quervain's tendinosis:

• Pain may be felt over the thumb side of the wrist. This is the main symptom. The pain may appear either gradually or suddenly. Pain is felt in the wrist and can travel up the forearm. The pain is usually worse when the hand and thumb are in use. This is especially true when forcefully grasping objects or twisting the wrist.

• Swelling may be seen over the thumb side of the wrist. This swelling may accompany a fluid-filled cyst in this region.

• A "catching" or "snapping" sensation may be felt when moving the thumb.

• Pain and swelling may make it difficult to move the thumb and wrist.

Common Management Techniques

Conservative Management

• Massage and releases 

• Dry needling 

• Specific exercises

• Tape/braces

• Heat or ice 

• Cortisone injections

• Anti-inflammatory medications

• Electrotherapy

• Daily ice massage will help—fill a paper/foam cup with water and freeze. Peel the top of the cup away to expose the ice and rub over the affected area in a circular motion for 5–7 minutes. 

• Modification of the activity that caused the problem and rest will help.  

Surgical Management

• Surgery may be recommended if symptoms are severe or do not improve. The goal of surgery is to open the thumb compartment (covering) to make more room for the irritated tendons.

Prognosis

Most cases of De Quervain’s can be self-managed with simple things such as modification of activities, simple exercises and if necessary, painkillers. In a small number of cases injections may be done around the tendon insertion and occasionally in unmanageable cases, surgery may be an option.