De Quervain’s tendonitis is a condition where the tendons along the lower part of the thumb become constricted or otherwise irritated. These tendons can swell and become inflamed (hence the term, “tendonitis”), and this can result in pain along the thumb and the part of the wrist on that side. This pain can be especially evident when a patient touches their wrist on that side (it can be quite tender), attempts to form a fist, or simply grips something while turning their wrist.
Tendons are rope or string-like tissues covered in a thin, soft, slippery layer known as “synovium”. All over the human body, tendons are what keep muscle attached to bone. There are two main tendons that run from the thumb down to the wrist, and it is these that De Quervain’s tendonitis affects. These tendons run through a sort of tunnel, aided by the slipperiness of the synovium. If the tendons become inflamed, however, it puts pressure on the surrounding nerves and does not move as easily through the “tunnel”. This in turn results in wrist pain or even finger numbness.
A number of things can cause tendonitis, including overuse. De Quervain’s tendonitis is most often found in women of middle age, though tendonitis in general has been associated with pregnancy. De Quervain’s tendonitis results when the tendons (along the wrist’s “thumb side”) become swollen or otherwise irritated, leading to the synovium also becoming swollen. This inflammation actually changes how the entire compartment is shaped. The tendons therefore do not move as easily as they normally would.
- Gradual or sudden pain (the primary symptom) that can travel from the wrist up the arm
- Pain that worsens when the thumb and hand are moved (particularly when twisting or grasping)
- Difficulty moving the wrist and thumb (as a result of pain and/or inflammation)
- Inflammation on the wrist’s thumb side (may occur in conjunction with fluid-filled cysts)
- “Snapping” or “catching” sensations when thumb is moved
- Numbness along the back of the index finger and thumb (a result of the irritated nerve sitting on the tendon sheath)
A technique called the “Finkelstein test” is used to examine the thumb and wrist. Your doctor will have you form a fist while keeping your fingers folded over your thumb. You will then be asked to bend your wrist down toward your little finger. People who have De Quervain’s tendonitis will usually experience great pain on the side of the wrist below the thumb. Tenderness in this area is also common for people with this condition.
The main objective while treating this condition is to achieve pain relief. While surgery is an option to treat the inflammation and irritation, conservative treatments should be attempted first in most cases. These include:
- Anti-inflammatory medications like aspirin or ibuprofen to reduce swelling and lessen pain.
- A splint or brace to stabilize the wrist and thumb.
- Avoiding any activities that may cause or worsen symptoms
- Injections of corticosteroids directly in the tendon sheath to reduce pain and swelling
Surgical intervention may be the best option if conservative treatments do not improve symptoms. Surgical treatment of De Quervain’s tendonitis involves opening up the tendon sheath to create more space for the inflamed and irritated tendons.
Once regular comfort levels and strength have returned following surgery, patients may begin using their hand normally again.