De Quervain’s Tenosynovitis

 

What is De Quervains tenosynovitis (tendonitis)?

De Quervains tenosynovitis is a painful condition in which the tendons that control the thumb become inflamed as they pass through a tunnel on the “thumb side” of the wrist. The tendons are the rope like structures that move different fingers of your hand. In this condition, the tendons that move the thumb away from the palm or up in the air become irritated, causing pain. 

What causes De Quervains tenosynovitis?

In most cases, the true cause of De Quervains tenosynovitis is unknown. Generally speaking, most believe that a thickening in the outer covering or tunnel of the tendon (the “first extensor compartment”) leads to an inability of the tendon to glide freely through the tunnel. The tendon becomes inflamed, causing significant amounts of pain upon thumb movement. New mothers are often afflicted with this condition; whether this is due to hormonal changes after pregnancy or due to lifting the baby repeatedly is not known. There is little evidence that suggests it is caused by work activities, but the pain can be aggravated by hand use.

 What may indicate I have De Quervains tenosynovitis?

Patients with de Quervain’s Tenosynovitis often describe significant pain and swelling at the base of the thumb or at the wrist. The pain is aggravated by lifting the thumb, such as in the hitchhiker position or while using scissors.

How will De Quervains tenosynovitis be diagnosed?

The diagnosis of De Quervains tenosynovitis is generally made on physical examination. Our hand surgery specialist will perform numerous physical exam maneuvers, and combined with the story of your injury, will determine if he suspects De Quervains tenosynovitis. Additional tests, such as an ultrasound may be ordered, to help diagnose the injury.

 If I have De Quervains tenosynovitis, what will be the treatment?

The goal in treating De Quervains tenosynovitisis is to eliminate the pain, thereby allowing full, painless movement of the thumb. Our specialists use an algorithmic approach to treat this common problem.

First, we will start with non-operative treatment measures such as splinting and changing the pattern in which you use your hand. We will then offer you a steroid injection. This is a simple procedure that can be done in the office, and is effective in fully treating the condition in about 50-70% of patients. If the pain returns, another steroid injection can be administered.

If the pain returns after the second steroid injection, surgical treatment may be considered.  Surgery involves a small procedure to release the tunnel that is compressing the tendon. Under local anesthesia, a small incision will be made, allowing our surgeon to meticulously dissect away the important nerves and vessels, and decompress the tunnel with an incision through its roof. Stitches will be placed to heal the incision, and you will be asked to perform light exercises immediately after surgery. Pain relief is rapid and recurrence of any pain after surgery is extremely rare.

Will I need therapy?

Most patients do not require formal hand therapy after surgery for De Quervains tenosynovitis. Motion is started immediately after surgery, and stiffness is very uncommon.

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