De Quervain’s Tendonitis
Although the exact cause of De Quervain’s (pronounced də kâr-vānz‘) tendonitis isn’t known, any activity that relies on repetitive hand or wrist movement — such as working in the garden, playing golf or racket sports, or even lifting a baby—can make it worse. Before letting it interfere with your life, you should meet with the extremely experienced orthopedic specialists at the Colorado Center of Orthopaedic Excellence in Colorado Springs, Colorado. Their expertise in DeQuervain’s tendonitis will ensure you get the best care possible.
De Quervain’s Tendonitis Overview
De Quervain’s tendonitis is one of the most common types of tendon inflammation. This painful inflammation of the tendon in the wrist and lower thumb was previously known by the name “washerwoman sprain” when it was first described by Swiss surgeon Fritz de Quervain in 1895. Today, however, it has also become known as “gamer’s thumb.” People with de Quervain’s typically experience pain in the wrist while pinching, grasping, making a fist, or stretching the wrist towards the small finger. Swelling and stiffness can also occur.
What Is De Quervain’s Tendonitis?
De Quervain’s tendonitis is an inflammation of the tendons, the strong cords of tissue that attach muscles to bones. Usually, tendons slide easily through a tunnel of tissue called a sheath. The sheath keeps the tendons in place next to the bones of the thumb. Tendons that easily slide through their sheaths allow the thumb to move without difficulty or pain. Any swelling of the tendons and/or thickening of the sheaths causes friction. The tendons can no longer easily slide through their sheaths. De Quervain’s tendonitis is often confused with a condition called De Quervain’s tenosynovitis. The difference is this; if only the tendons become inflamed, it is De Quervain’s tendonitis. When both the tendon and the tendon sheath in the wrist near the thumb are inflamed, it is called De Quervain’s tenosynovitis.
De Quervain’s tendonitis can be triggered by several factors, including:
- A direct blow to the thumb
- Repetitive grasping
- Inflammatory conditions such as arthritis
- Activities that require a sidewise motion of the wrist while gripping something
- Lifting a child into a car seat
- Lifting heavy grocery bags by the handles
- Racket sports
- Using a hammer
- Pain near the base of the thumb
- Pain that may extend from the forearm to the thumb base
- Swelling near the base of the thumb
- Feeling a snapping or popping sensation in the wrist when moving the thumb
- Pain and tenderness along the side of the wrist on the thumb side
- Pain that worsens with the use of the hand and thumb
- Pain that appears suddenly or develops over time
- Age. Adults between 30 and 50 are most likely to get it
- Gender. Women are 8 to 10 times more likely to get it than men
- Being pregnant. The condition may be associated with pregnancy
- Baby care. Lifting a child repeatedly involves using the thumbs as leverage
- Jobs or hobbies that involve repetitive hand and wrist motions, such as bricklayers, fly fishermen, and piano players, among others
- It also has an association with rheumatoid arthritis
Treatment for De Quervain tendonitis aims to reduce inflammation, preserve movement in the thumb, and prevent a recurrence. Initial treatment may include: Immobilizing the thumb and wrist, keeping them straight with a splint or brace to help rest the tendons, applying ice, or taking non-prescription, anti-inflammatory pain relievers such as Advil, Motrin IB, or Aleve to help reduce pain and swelling. A physical or occupational therapist can teach wrist, hand, and arm exercises that both strengthen muscles, reduce pain and limit tendon irritation. Steroid injections into the sheath may also be considered.
When Is Surgery Indicated?
For people with more serious cases with symptoms that do not resolve, a surgical procedure may be required to help create more room for the compressed tendon. De Quervain’s surgery is also commonly called “De Quervain’s release.” During this outpatient procedure, a local anesthetic is used to numb both hand and wrist. The hand surgeon makes a small incision on the wrist near the base of the thumb. From there, the surgeon will locate the inflamed tendon and cut a small slit in the sheath surrounding the tendon. That slit will release pressure and allow the tendons to move more freely. Cases that require surgery have a high success rate.
Getting The Right Diagnosis
De Quervain’s tendonitis is relatively simple to diagnose in the doctor’s office. First, the doctor will examine the hand, applying pressure to the wrist near the base of the thumb. A technique specifically designed to test for De Quervain’s is called the Finkelstein test. It involves first bending the wrist toward the baby or “pinky” finger, then bending the thumb across the palm. If the test is done correctly, people with the condition will feel pain in the area surrounding the thumb. Imaging tests such as X-rays generally aren’t needed to diagnose De Quervain’s tendonitis. But here is where you need excelled orthopedic specialists. A true diagnosis involves differential consideration of other conditions that may co-exist with De Quervain’s, including carpal tunnel syndrome, dorsal wrist ganglions, and cervical radiculopathies, sometimes called a “pinched nerve.” In the end, nothing can replace experience, expertise, and quality of care like that you’ll receive at CCOE in Colorado Springs, Colorado.