De Quervain's Tenosynovitis

De Quervain's tenosynovitis is a painful condition that affects the two tendons located on the thumb side of the wrist. These tendons, called abductor pollicis longus (APL) and extensor pollicis brevis (EPB) are encased in a tendon sheath. Repeated movement can cause the tendon sheath to become inflamed and thickened. This can squeeze the tendons and prevent them from operating properly.

Specialists at the Midwest Orthopaedics at Rush (MOR) Hand, Wrist & Elbow Institute offer the most advanced treatment options to treat this and other hand conditions.

What are the symptoms of de Quervain's tenosynovitis?

The first symptom of de Quervain's tenosynovitis is usually pain and swelling in the wrist on the thumb side. It may also be difficult to grab and pinch things. The pain may increase and hurt along the tendons up to the thumb. In severe cases, a small, firm nodule may develop at the base of the thumb and a noise may be heard from the tendons rubbing against each other.

Symptoms of de Quervain's tenosynovitis include:

  • Pain in wrist
  • Pain at base of thumb
  • Swelling near base of thumb
  • Difficulty grasping or pinching

Who is likely to get de Quervain's tenosynovitis?

While this condition can affect anyone, it is most often seen in people ages 30-50 and is more common among women. Those who do repetitive motions in the thumb and wrist, such as when playing tennis or working, are more likely to experience de Quervain's tenosynovitis. It is also very common in new moms or those who frequently hold small children due to the way we posture the wrist when holding a child.

What causes de Quervain's tenosynovitis?

De Quervain's tenosynovitis is usually caused by overuse of the wrist. Repetitive wringing, grasping, clenching or pinching can cause irritation and inflammation that presses on the tendons, restricting their ability to move. Less common causes include rheumatoid arthritis and scar tissue from a previous injury.

How is de Quervain's tenosynovitis diagnosed?

Diagnosis of de Quervain's tenosynovitis is determined with a careful examination by an experienced physician. Pinpointing the pain and discussing lifestyle, work and medical history are typically required for a proper diagnosis. Lab tests and X-rays are usually not necessary, but may rule out other possible conditions.

What are the treatment options for de Quervain's tenosynovitis?

Treatment options may include the following and will depend on severity of the condition:

Non-surgical Treatment Options

  • Wrist brace
  • Anti-inflammatory medication
  • Restricted movement of wrist
  • Ice
  • Cortisone injections
  • Physical or occupational therapy

Non-surgical treatments can be effective if treated early and activities that caused de Quervain's tenosynovitis are stopped. If such activities resume, as may be necessary for work, the tenosynovitis can worsen. If non-surgical treatments are not effective in relieving pain and restoring function of the hand and wrist, surgery may be required.

Surgical Treatment Options

Through a small incision, a small slit is made in the tendon sheath that encases the tendons. This releases pressure on the tendons so they stop rubbing against each other and inflammation can subside. This is considered a minimally invasive outpatient procedure and is typically performed with a local anesthetic.