Anatomy of the Tendons of the Hand
The muscles and bones of your hand are connected by thick flexible tissue called tendons. Tendons are covered by a thin soft sheath of tissue known as synovium. Extensor pollicis brevis and abductor pollicis longus are two tendons located on the thumb side of the wrist.
What is De Quervain's Tendinosis?
Inflammation and swelling of the tendon sheaths put pressure on the adjacent nerves and leads to pain and numbness in the thumb side of the wrist. Strain on these tendons can cause swelling and irritation, and lead to a condition called De Quervain's tenosynovitis, which is characterized by inflammation. The condition is also referred to as De Quervain's tendinitis, De Quervain's tendinosis, De Quervain's syndrome or De Quervain's disease.
Causes of De Quervain's Tendinosis
The exact cause of De Quervain's tenosynovitis is unknown, but is usually seen in individuals with repetitive hand and wrist movements or injury to the wrist or tendons. De Quervain's tenosynovitis is common in pregnant and middle-aged women.
Signs and Symptoms of De Quervain's Tendinosis
The symptoms of De Quervain's tenosynovitis include pain and tenderness on the radial side of the wrist at the base of your thumb. You may also have a little swelling and redness in the area. Your symptoms may get worse while making a fist, grasping or gripping objects, or turning the wrist. You may experience a "catching" or "snapping" sensation while moving your thumb or wrist. Picking up your child may reproduce the pain.
Diagnosis of De Quervain's Tendinosis
Dr. Miller diagnoses De Quervain's tenosynovitis by observing your symptoms, medical history and performing a physical examination of the wrist. De Quervain's tenosynovitis can be confirmed through the Finkelstein test. For this test, Dr. Miller will ask you to make a fist with your fingers covering the thumb, and bend the wrist towards your little finger. Pain during this movement will confirm the condition.
Treatment for De Quervain's Tendinosis
The treatment of De Quervain's syndrome consists of both non-surgical and surgical therapy.
Non-surgical therapy includes avoiding activities that increase pain and swelling, applying ice, using a splint to support and immobilize the wrist and thumb (thumb spica splint), and occupational therapy. Anti-inflammatory drugs are helpful in relieving pain and swelling. Dr. Miller may also recommend an ultrasound guided corticosteroid injection to reduce the swelling of the tendon sheath. Conservative measures are successful 90 percent of the time.
Dr. Miller will recommend surgery based on the severity of your pain symptoms and response to non-surgical treatment methods. The outpatient surgical procedure involves opening or cutting the inflamed region of the tendon sheath to relieve the pressure on the tendon and allow free movement of the wrist. This oftentimes can be performed under local anesthesia.
Postoperative Care following Surgery for De Quervain's Tendinosis
After the surgical procedure, a wrist splint is used for a month with your thumb and fingers are free and mobile. Dr. Miller will also instruct you on exercises to strengthen your wrist. Therapy postoperatively is rarely needed. Return to weight bearing and full activities at one month postoperatively.