A condition caused by inflammation of the tendons and sheath that leads to pain in the wrist or thumb with use.
What is it?
DeQuervain’s tendonitis is a condition that causes pain in the wrist and/or the base of the thumb. The tendons that attach to the thumb pass through a fleshy tunnel on the outside of the wrist called a tendon sheath. Normally, this tunnel is lubricated by synovial fluid that results in painless thumb and wrist motion. Tendonitis results in swelling of the tendons in the sheath, which can restrict the tendons’ movement and cause pain with use of the hand and thumb.
What causes it?
DeQuervain’s tendonitis comes from inflammation of the tendons or tendon sheath following repetitive activities or chronic overuse of the hand and wrist. Direct injury is a less common cause of DeQuervain’s tendonitis. Risk factors include jobs or hobbies where repetitive hand and wrist motions are necessary, such as carpentry, office work, or needlework. The condition occurs most frequently in middle-aged women.
What are the symptoms?
The most common symptom is pain in the wrist or thumb with activities that involve twisting or a side to side motion of the wrist, such as lifting, opening doors, or reaching behind your back. A thickening of the tendons can develop as they pass back and forth over the wrist. The pain can become severe as the condition worsens, and can feel as if it is radiating across the whole wrist or up into the arm.
How is it diagnosed?
A history of pain on the thumb side of the wrist is consistent with DeQuervain’s tendonitis. Examination will often reveal a positive Finkelstein test. This is done by forcefully moving the patient’s wrist and thumb from side to side. X-rays and other special tests like an MRI are not always necessary for diagnosis, but may be used to exclude other conditions, such as arthritis or a fracture.
What are the treatments?
The initial treatment consists of a steroid injection, splinting, and activity modifications. This should be followed with a short course of ice massage reduce any post-injection pain and swelling. The injection should be effective within two weeks, and may be repeated, if necessary. If two injections do not result in adequate pain relief, a cast may be applied for two weeks for more complete immobilization of the wrist. A short course of occupational therapy may also be employed. When non-operative treatment fails, surgery is often recommended. A small incision is made over the wrist and the sheath is cut over the tendons, which relieves the friction and allows the inflammation to resolve. The surgery is performed in an outpatient facility, and does not usually require general anesthesia.
What happens after surgery?
After surgery, you will be placed in a splint, and you will need to rest the hand and wrist for a week. At your one week post operative/occupational therapy visit, your bandage and sutures will be removed, and you will start therapy. You will wear your brace from before surgery for approximately three more weeks, and limit lifting and heavy use. You should regain full use of your hand/wrist between four to six weeks after surgery.
Complications following the DeQuervain’s tendon release are very uncommon and include infection, scar tenderness, stiffness, and pain. Recurrence of the tendonitis is possible. Once you have had surgery, it is important to follow guidelines to prevent recurrence of this problem. Sometimes, a change of employment or job adaptations are necessary in order to accomplish this.
