Hand and Wrist

De Quervain's Tendinitis

Anatomy

Tendons are tissues that connect muscles to bone. Two of the main tendons to the thumb pass through a tunnel located on the thumb side of the wrist. Tendons are covered by synovium, a slippery thin soft-tissue layer that enables the tendons to slide through this tunnel easily.

Description

De Quervain's tendinitis occurs when the tendons around the base of the thumb become irritated or swollen, causing the synovium around the tendon to swell and changing the shape of the compartment, which makes it difficult for the tendons to move properly. This can cause pain and tenderness along the thumb side of the wrist and is particularly noticeable when grasping or gripping, forming a fist, or turning the wrist.

Symptoms

The primary symptom of De Quervain's tendinitis is pain in the thumb side of the wrist. Pain may appear gradually or suddenly, is felt in the wrist but can also travel up the forearm, worsening when the hand and thumb are in use, especially when grasping forcefully or twisting the wrist. Swelling may appear in the thumb side of the wrist, possibly occurring together with a fluid-filled cyst in the same region. You may have a catching or snapping sensation when moving the thumb, and pain and swelling may make it difficult to move the thumb and wrist. Numbness of the back of the thumb and index finger may also result from irritation of the nerve lying on top of the tendon sheath.

Causes

Frequently a result of overuse, De Quervain's tendinitis is also associated with pregnancy and inflammatory arthritis, such rheumatoid disease.

Diagnosis

Your physician may perform the Finkelstein test by having you make a fist with your fingers closed over the thumb and your wrist bent toward the little finger. Tenderness directly over the tendons on the thumb side of the wrist is a common finding of this test, which can be quite painful for someone suffering from De Quervain's tendinitis.

Nonsurgical Treatment

Nonsurgical options to relieve pain caused by irritation and swelling include: splints to give support/provide rest for the thumb and wrist; anti-inflammatory medications (NSAIDs) taken by mouth or injected into the tendon compartment; or corticosteroids injected into the tendon sheath. Simply avoiding activities that cause pain and swelling may be enough to allow your symptoms to abate on their own, without additional treatment.

Surgery

If symptoms are severe or do not improve with nonsurgical treatments, surgery may be needed to open the compartment, or sheath, to make more room for the inflamed tendons. Use of the hand is typically resumed once comfort and strength have returned.