De Quervain's Tenosynovitis is inflammation of the synovium or sheath that surrounds two tendons in the wrist which attach to the base of the thumb. It is a form of repetitive strain injury which can be exacerbated by sporting and work activities. The inflammation can cause pain and restrict movement in the wrist, but in most cases it can be treated without surgery.
Symptoms of De Quervain's tenosynovitis
Symptoms include pain and tenderness on the thumb side of the wrist where the tendons pass through a narrow tunnel and attach to the base of the thumb. Crepitus or a creaking sensation may be felt when moving the wrist.
Finkelstein's test is used to help diagnose De Quervain's tenosynovitis. The thumb is placed in the palm of the hand and the wrist moved sideways towards the little pinky finger side to stretch the tendons. If the pain is felt the test is positive.
De Quervain's explained
The tendons of the of the abductor pollicis brevis and extensor pollicis longus muscles pass through a tunnel or tube in the wrist and attach at the base of the thumb. This tube or sheath surrounding the tendons can become inflamed preventing normal movement of the tendon and creating pain. Tenosynovitis is inflammation of the sheath that surrounds the tendon as opposed to inflammation of the actual tendon itself which is known as tendinitis or tendonitis.
It occurs more frequently in racket sports such as tennis, squash or badminton as well as canoeing and ten pin bowling. Any sport or work-related activity which involves repetitive wrist flexion and extension or ulna and radial deviation (side to side movements) can bring on De Quervain's tenosynovitis.
It also occurs in golfers (left thumb of a right-handed golfer and vice versa). Tendon injuries such as this are often labeled with the umbrella term RSI (repetitive strain injury).
Treatment for De Quervain's tenosynovitis
Conservative treatment is usually very successful and consists or rest, ice, ultrasound and a stretching and strengthening program. Rest is important to allow healing and often a wrist splint can ensure rest and help prevent painful movement.
Applying ice or cold therapy can reduce pain and inflammation. Do not apply ice directly to the skin as ice burns may occur. Apply for up to 10 minutes every hour for the first day or so then as required. A doctor may prescribe anti-inflammatory medication such as Ibuprofen. Ultrasound therapy applied to the tendons can also help reduce pain and inflammation and encourage the healing process. Ultrasound passes high-frequency sound waves into the tissues vibrating the molecules resulting in a micro-massage effect.
If conservative treatment fails then a cortisone injection may be given. This is usually successful in most cases, however in rare cases where both conservative treatment and cortisone injections have failed then surgery may be indicated.
Once the pain has gone it may be necessary to do wrist and hand exercises to strengthen up the whole area in preparation for returning to the sport in order to help prevent future injury.
Consultant wrist and hand surgeon Mr. Elliot Sorene explains De Quervain's tenosynovitis
"They pass through a tunnel or tube which can become inflamed and the tendons become stuck. This can cause a great deal of pain, particularly on certain movements of the wrist. It is most common in patients during pregnancy or after pregnancy. It is also common in certain sports activities and work activities involving repetitive flexion and extension of the wrist as well as ulna and radial deviation. The patient can get a painful nodule on the tendon.
De Quervain's tenosynovitis can be treated conservatively with rest, ice, anti-inflammatory medication and splinting. If this doesn't solve the problem, one steroid injection usually does the trick. Failing this these is surgery to release the tendon and that means opening the tube which the tendon runs through to allow it to run through smoothly which will stop the pain."