Diseases & Conditions

De Quervain's tenosynovitis

Working in the garden, playing music, knitting, cooking and walking your pet can all be enjoyable activities, but if these activities cause pain in your wrist and hand, you may have a condition known as de Quervain's tenosynovitis.

In de Quervain's tenosynovitis, the sheath of the tendons on the thumb side of your wrist becomes inflamed or swollen, restricting the tendons' movement. The result with de Quervain's tenosynovitis is discomfort and pain every time you turn your wrist, grasp anything or make a fist.

Treatment for de Quervain's tenosynovitis may range from immobilizing your wrist and taking medications to surgery in more serious cases. If you start treatment early on, your symptoms of de Quervain's tenosynovitis should generally improve within four to six weeks.

Consult your doctor if you're still having problems with pain or function and you've already tried:

• Avoiding repetitive thumb movements whenever possible
• Avoiding pinching with your thumb when moving your wrist from side to side
• Applying heat to the affected area
• Using nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve)

If the pain continues to interfere in your daily life or activities, seek medical advice.

Your doctor may confirm a diagnosis of de Quervain's tenosynovitis by doing a Finkelstein test. In this simple test, you bend your thumb across the palm of your hand and bend your fingers down over your thumb. Then you bend your wrist toward your little finger. If this causes pain on the thumb side of your wrist, the test is considered positive.

If you feel pain about three inches up your forearm, you may have a condition called intersection syndrome. This is similar to de Quervain's tenosynovitis, but affects a different area of your wrist and requires different treatment.

Left untreated, de Quervain's tenosynovitis may permanently restrict movement of the tendons of your wrist, making it difficult for you to bend your wrist, pinch, grasp or make a fist. The tendon sheaths could rupture. Additionally, an underlying infection may spread into your hand or your arm, causing further pain and discomfort.

To reduce pain and swelling, initial treatment of de Quervain's tenosynovitis may include:

• Immobilizing your thumb and wrist, keeping them straight with a splint or brace to help rest your tendons
• Avoiding repetitive thumb movements whenever possible
• Avoiding pinching with your thumb when moving your wrist from side to side
• Applying heat to or icing the affected area
• Using nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve)

Your doctor may also recommend injections of corticosteroid medications into the tendon sheath to reduce swelling.

Treatment is generally successful if begun early on, though overuse injuries often recur if you have difficulty discontinuing the repetitive motions that caused the condition in the first place.

Making adjustments
Your medical team may include a physical therapist or occupational therapist who may monitor your habits and give suggestions on how to make necessary adjustments to relieve stress on your wrists. Your therapist can also teach you exercises focused on your wrist, hand and arm to strengthen your muscles, reduce pain and limit the irritation of the tendons.

In more serious cases
If your case is more serious, your doctor may recommend outpatient surgery. Surgery involves a procedure in which your doctor inspects the sheath surrounding the involved tendon or tendons, and then opens the sheath to release pressure.

If you don't need surgery, caring for your condition is much the same as preventing it:

• Avoid repetitive hand and wrist movements.
• Wear a brace or splint if suggested by your doctor.
• Follow through with recommended exercises.
• Take special note of any activity that causes pain, swelling or numbness in your thumb and wrist, try to avoid it, and share that information with your doctor.

If you do need surgery, it may be several months before the tenderness in your wrist completely goes away. Your doctor will talk to you about how to rest, strengthen and rehabilitate your body after surgery. Your physical or occupational therapist will meet with you regularly to assess your progress, teach you new strengthening exercises, and help you adjust your daily routine to prevent a recurrence of the condition.