DeQuervain’s tenosynovitis, also called stenosing tenosynovitis, occurs when tendons around the base of the thumb are irritated or constricted. This is typically caused by overuse especially from activities that require forceful gripping while flexing and extending the wrist.
More specifically, the condition involves inflammation of the lining of the sheath (synovium) that surrounds two tendons of the thumb: Abductor Pollicis Longus and Extensor Pollicis Brevis. The inflammation prevents the tendons from gliding smoothly through a tunnel located on the thumb side of the wrist. When the synovium of these tendons becomes inflamed friction occurs with certain thumb and wrist movements, which ultimately causes pain and discomfort.
De Quervain’s is more common in women than in men, and almost 50% of new mothers experience this condition. It has a tendency to develop during pregnancy, when fluid may be retained. It may also develop during menopause.
This condition is also common to people who use their hands in repetitive motions, such as constant gripping, forcefully bending the wrist, placing the wrist in awkward positions, or engaging in lifting or pinching activities. It can also be caused by direct trauma or sudden incorrect lifting, and it is sometimes associated with conditions such as diabetes, rheumatoid arthritis and hypothyroidism.
De Quervain’s was named after the Swiss surgeon who first described the condition in 1895. It is one of the most common types of tendon lining inflammation (also called tenosynovitis).
Causes
De Quervain tenosynovitis is basically a combination of overuse and poor hand on wrist posture.
- Repeated hand and thumb motions such as grasping, pinching, squeezing, or wringing may lead to the inflammation of tenosynovitis.
- Holding the hand at an angle to the wrist creates a compression point that excessively rubs the tendon.
- This inflammation can lead to swelling, which restricts the smooth gliding action of the tendons within the tunnel.
- Scar tissue from a previous injury can make it difficult for the tendons to slide easily through the tunnel.
- Arthritic diseases that affect the whole body, such as rheumatoid arthritis, can also cause tenosynovitis in the thumb.
Risk Factors
The cause of de Quervain’s tenosynovitis is idiopathic or unknown. However, there are certain risk factors that may increase the chance of developing the condition. These can include the following –
- Gender – The condition is more common in females than males.
- Age – It occurs more frequently around ages 30-50.
- Social Habits – The condition may be caused by overuse such as with frequent texting or typing on mobile devices with your thumbs.
- Work Habits – Occupations that require repetitive hand and wrist movements such as with construction or playing music may increase your risk of developing the condition.
- Medical Conditions – Patients with diabetes, alcoholism, cirrhosis of the liver, and seizure disorders appear to be at increased risk of developing the condition.
Symptoms
The main symptom of de Quervain’s tenosynovitis is pain or tenderness at the base of the thumb. Some might also feel pain going up your forearm. The pain may come on suddenly or develop slowly. It may get worse when using hand and thumb.
Other symptoms of de Quervain’s tenosynovitis include the following –
- 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 near the base of the thumb
- A fluid-filled cyst in the affected area, which may or may not bulge through the skin
- Numbness along the back of the thumb and index finger
- A “catching” or “snapping” feeling when a person moves the thumb
- A squeaking sound as the tendons move within the swollen sheaths
Treatment
Splints – Splints may be used to rest the thumb and wrist.
Anti-inflammatory medication (NSAIDs) – These medications can be taken by mouth or injected into a tendon compartment. This may help reduce swelling and relieve pain.
Avoiding activities that cause pain and swelling – This may allow the symptoms to go away on their own.
Corticosteroids – Injection of corticosteroids into the tendon sheath may help reduce swelling and pain.
Surgery – 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.
Occupational therapy – A hand therapist will conduct a full evaluation and may then provide one or more the following –
- A custom-fitted orthosis (brace) that will rest the thumb/wrist and help reduce the inflammation.
- Deep tissue massage of the thumb/wrist.
- Myofascial release techniques (gentle stretching).
- Ultrasound massage.
- As the pain decreases, therapeutic exercises to stretch and strengthen the area.
- An ergonomic assessment and training to prevent further damage, along with recommendations for optimal ways for people to continue their activities of daily living.
- Advice to new mothers on how to lift their babies, the baby carrier, or baby bottle to prevent this condition
Alternative Treatment
Bromelain – This enzyme that comes from pineapples reduces inflammation.
Vitamin C to aid in healing, increase immune function, and reduce inflammation.
Calcium helps to aid healing of connective tissues and muscles.
Vitamin A is used for immune function and healing. Do not use if you are or may become pregnant.
Vitamin E and essential fatty acids, such as fish oil or evening primrose oil helps to reduce inflammation. Vitamin E may interact with a number of medications.
Turmeric – Used for pain and inflammation. Turmeric is sometimes combined with bromelain, because it makes the effects of bromelain stronger.
Willow bark helps to relieve pain. Willow acts similar to aspirin.
Licorice helps to reduce inflammation.
Complementary Treatment
Radial Deviation – Radial deviation exercises are designed to strengthen the wrist, which will alleviate pressure on the tendons and reduce symptoms.
Wrist Flexion and Extension Strengthening – This exercise is similar to the wrist flexion and extension stretches, except you will be holding a weight in the hand to provide resistance.
Finger Abduction With Rubber Band – Resisted finger abduction exercises such as this will also help strengthen the muscles in the hands, which will help alleviate the symptoms and prevent future cases of this condition.
Thumb adduction stretches will stretch the thumb and ameliorate stiffness.
Reference –
http://familydoctor.org/familydoctor/en/diseases-conditions/de-quervains-tenosynovitis.html
http://www.med.und.edu/users/jwhiting/dess.html
http://www.handsurgery.com.au/services/de-quervains-tenosynovitis/
http://www.houstonmethodist.org/orthopedics/where-does-it-hurt/wrist/de-quervains-tenosynovitis/
http://www.wesleyhandcentre.com.au/pdf/de-quervains-tenosynovitis.pdf
http://www.webmd.com/rheumatoid-arthritis/de-quervains-disease
http://emedicine.medscape.com/article/1243387-overview
https://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000537.htm
http://orthoinfo.aaos.org/topic.cfm?topic=a00007