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De Quervain’s Tenosynovitis
Dr Kau Chung Yuan (许医生)
MBBS (S’PORE)
MRCS (Ireland)
MMed (Ortho)
FRCSEd (Ortho)
What is De Quervain’s Tenosynovitis?
De Quervain’s tenosynovitis is one form of wrist and hand tendon injuries that can develop when repetitive movement irritates the tendons around the wrist and thumb. This condition develops when tendons near the thumb base become irritated or constricted. The sheath surrounding these tendons, known as the synovium, becomes inflamed, leading to pain and difficulty in moving the thumb and wrist, especially when performing actions that involve gripping or twisting.
Causes
The precise cause of De Quervain’s tenosynovitis is not always clear, but several factors are known to contribute to its development. These factors can increase the risk of developing the condition:
- Repetitive Motion
Engaging in repetitive hand and wrist movements, especially those that involve pinching, grasping, or wringing, can strain the tendons in the wrist. This repetitive strain is a common cause among people whose occupations or hobbies require such motions. - Inflammatory Conditions
Conditions that cause inflammation throughout the body, such as rheumatoid arthritis, can also lead to inflammation of the tendons in the wrist, resulting in De Quervain’s tenosynovitis. - Pregnancy
Hormonal fluctuations and fluid retention during pregnancy can contribute to the development of De Quervain’s tenosynovitis, making it more common among pregnant women. - Direct Injury
A direct injury to the wrist or thumb can cause swelling and inflammation of the tendons, potentially leading to this condition. - Age and Gender
De Quervain’s tenosynovitis can occur at any age. Women are more likely to develop the condition than men, possibly due to anatomical differences or hormonal factors.
Symptoms
The symptoms of De Quervain’s tenosynovitis can vary in intensity from person to person but typically include:
- Pain and Tenderness
Pain is usually concentrated around the base of the thumb and can extend up the forearm. The pain may develop gradually or suddenly and is often exacerbated by movement of the thumb or wrist. - Snapping or Catching Sensation
In some cases, people may experience a feeling of snapping or catching when moving the thumb, due to the swollen tendons passing through the narrowed tunnel. - Difficulty Moving the Thumb and Wrist
Movements such as grasping, pinching, or making a fist can become difficult and painful, affecting the ability to perform everyday tasks. - Swelling
Swelling over the thumb side of the wrist is another common symptom, which can sometimes lead to a fluid-filled cyst in the same area. - Numbness
There may be numbness on the back of the thumb and index finger, which is caused by the irritation of nerves lying close to the inflamed tendons.
Diagnosis
The diagnosis of De Quervain’s tenosynovitis is primarily based on clinical examination and the patient’s history. Key elements in the diagnostic process include:
Medical History
An orthopaedic surgeon will engage with the patient to understand their symptoms, the onset of these symptoms, and any relevant activities or situations that might have led to the condition.
Physical Examination
During the physical exam, the orthopaedic surgeon will assess for pain, swelling, and tenderness along the thumb side of the wrist. One common test used is the Finkelstein test, where the patient tucks the thumb into the palm, makes a fist with the fingers closed over the thumb, and then bends the wrist towards the little finger. This test is considered positive if it elicits pain on the thumb side of the wrist, indicative of De Quervain’s tenosynovitis.
Imaging Tests
While not always necessary, imaging tests like X-rays can be used to rule out other conditions that might cause similar symptoms, such as arthritis or fractures.
Ultrasound and MRI
In some cases, ultrasound or MRI scans may be employed to evaluate the condition of the tendons and the surrounding structures in greater detail.
Non-Surgical Treatment Options
Non-surgical treatment options for De Quervain’s tenosynovitis focus on reducing inflammation, alleviating pain, and preventing further irritation of the tendons. These options can be highly effective, especially when the condition is diagnosed early. The main non-surgical treatments include:
Rest
Avoiding activities that exacerbate the pain is crucial. This may involve taking a break from repetitive hand and wrist movements that strain the affected tendons.
Splinting
Wearing a splint that immobilises the thumb and wrist can help reduce irritation by limiting movement. Splints are typically worn for several weeks.
Ice Packs
Applying ice packs to the affected area for short periods can reduce swelling and alleviate pain.
Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
Medications such as ibuprofen or naproxen can help reduce pain and inflammation.
Corticosteroid Injections
Injecting corticosteroids into the tendon sheath can significantly reduce inflammation and pain. While highly effective for many patients, the number of injections is generally limited to prevent potential side effects.
Physical Therapy
Physical therapy can be beneficial in strengthening the muscles around the wrist and improving the range of motion. Therapists may also use techniques such as massage, ultrasound, or stretches to help alleviate symptoms.
Surgical Treatment Options
When non-surgical treatments for De Quervain’s tenosynovitis do not lead to significant improvement, surgical intervention may be considered. This is typically achieved through a procedure known as tendon sheath release. Here are the key aspects of surgical treatment:
Local Anaesthesia
This procedure is commonly performed under local anaesthesia, allowing the patient to remain awake while the area around the surgery is numbed.
Procedure Overview
The surgery involves a small incision near the base of the thumb on the affected wrist. Through this incision, the orthopaedic surgeon cuts the sheath surrounding the inflamed tendons, relieving constriction and allowing the tendons to glide more easily.
Dr. Kau Chung Yuan
MBBS (S’pore)
MRCS (Ireland)
MMed (Ortho)
FRCSEd (Ortho)
Dr Kau (许医生) is a Fellowship trained Orthopaedic Surgeon with a subspecialty interest in Hip and Knee surgery and has been in practice for more than 15 years.
He is experienced in trauma and fracture management, sports injuries, and joint replacement surgery.
- Fellow of the Royal College of Surgeons Edinburgh, Orthopaedics (FRCS, Edin) 2014
- Master of Medicine (Orthopaedics), Singapore (MMed) 2013
- Member of the Royal College of Surgeons Ireland (MRCS, Ire) 2009
- Bachelor of Medicine and Surgery (MBBS, Singapore) 2004
Prevention Strategies
Preventing De Quervain’s tenosynovitis involves measures aimed at reducing strain on the wrists and tendons, especially for people who engage in repetitive hand and wrist movements. Here are some strategies that can help prevent the onset or recurrence of this condition:
- Ergonomic Adjustments: Making changes to workspaces to ensure ergonomic positioning of the hands and wrists can significantly reduce strain. For instance, adjusting chair and desk height, using ergonomic keyboards, and ensuring that the wrist is not bent excessively while typing or using a mouse.
- Frequent Breaks: Regular breaks during activities involving repetitive motion can help prevent overuse of the tendons. Stretching the hands, wrists, and fingers during these breaks can also be beneficial.
- Strengthening Exercises: Exercises that strengthen the muscles around the wrist and thumb can improve their endurance and resilience, reducing the risk of tendon irritation.
- Proper Technique: Learning and adhering to proper techniques for activities that involve the hands and wrists can minimise stress on the tendons. This is particularly important in sports and certain occupations.
- Use of Splints: For people who have experienced De Quervain’s tenosynovitis or are at high risk, wearing a supportive splint during activities that could strain the wrist may offer protection.
- Manage Inflammatory Conditions: For those with conditions like rheumatoid arthritis, managing the underlying inflammation can help reduce the risk of developing De Quervain’s tenosynovitis.
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Frequently Asked Questions (FAQs)
Can De Quervain’s Tenosynovitis Go Away on Its Own?
In some cases, mild symptoms of De Quervain’s tenosynovitis may improve with rest and self-care measures, such as ice application and avoiding activities that exacerbate the condition. However, without proper treatment, symptoms may persist or worsen over time.
How Long Does It Take to Recover from De Quervain’s Tenosynovitis?
The recovery time can vary depending on the treatment approach. Non-surgical treatments like splinting, NSAIDs, and corticosteroid injections can offer symptom relief within a few weeks.
Surgical recovery may take longer, with most patients experiencing significant improvement within a few weeks to months post-operation.
Is De Quervain’s Tenosynovitis a Form of Arthritis?
No, De Quervain’s tenosynovitis is not a form of arthritis. It is a condition that affects the tendons and their sheaths in the wrist, leading to inflammation and pain. People with rheumatoid arthritis may be more prone to developing the condition due to the inflammatory nature of arthritis.