De Quervain’s Tendinosis ( Disease & Conditions, Treatments & Procedures , Symptoms )

De Quervain’s tendinosis, also known as De Quervain’s tenosynovitis, is a painful condition that affects the tendons on the thumb side of the wrist. It is caused by inflammation or irritation of the tendons that control the movement of the thumb. This can result in pain, swelling, and difficulty moving the thumb and wrist. The condition is most commonly seen in middle-aged women, and may be caused by repetitive activities that involve gripping, twisting, or pinching. Treatment may include rest, splinting, anti-inflammatory medication, and physical therapy. In severe cases, surgery may be necessary.

This article covers the following topics :

What is de Quervain’s tendinosis?

De Quervain’s tendinosis, also known as De Quervain’s tenosynovitis, is a condition that affects the tendons that control the movement of the thumb. Specifically, it involves inflammation or irritation of the tendons that run through a tunnel on the thumb side of the wrist, known as the first dorsal compartment. The condition can result in pain, swelling, and difficulty moving the thumb and wrist.

Causes:

De Quervain’s tendinosis is most commonly caused by repetitive activities that involve gripping, twisting, or pinching, such as using a computer mouse, gardening, or playing a musical instrument. It can also be caused by injury or trauma to the wrist or thumb, and in some cases, may be associated with underlying medical conditions such as rheumatoid arthritis.

Symptoms:

The most common symptoms of De Quervain’s tendinosis include pain and tenderness on the thumb side of the wrist, which may radiate up the forearm. The pain is usually worsened with gripping or twisting motions, and may be accompanied by swelling or a “creaking” sensation when moving the thumb. In some cases, there may be a lump or bump on the wrist.

Diagnosis:

Diagnosis of De Quervain’s tendinosis is usually made based on a physical examination of the wrist and thumb, along with a review of the patient’s medical history and symptoms. In some cases, imaging tests such as X-rays or MRIs may be performed to rule out other conditions.

Treatment:

Treatment for De Quervain’s tendinosis typically begins with conservative measures, such as rest, immobilization of the thumb and wrist with a splint, and the use of anti-inflammatory medication to reduce pain and swelling. Physical therapy may also be recommended to help improve range of motion and strength in the affected wrist and thumb. In severe cases, where conservative measures do not provide relief, surgery may be necessary to release the tendons and relieve pressure on the first dorsal compartment.

Prevention:

Prevention of De Quervain’s tendinosis involves avoiding repetitive activities that put strain on the tendons in the thumb and wrist. This may include taking frequent breaks during activities that involve repetitive motions, using ergonomic equipment to reduce strain on the wrist and thumb, and performing stretching and strengthening exercises to improve the strength and flexibility of the wrist and thumb muscles.

Overall, De Quervain’s tendinosis can be a painful and debilitating condition, but with proper treatment and preventive measures, it can be managed effectively.

How common is de Quervain’s tendinosis?

De Quervain’s tendinosis is a relatively common condition, but its exact prevalence is not well established. It is more commonly seen in women than in men, and typically affects adults between the ages of 30 and 50. Some studies suggest that it may occur in up to 10% of the population, although this varies depending on factors such as age, gender, and occupation. It is more common in people who perform repetitive motions that involve the thumb and wrist, such as office workers, musicians, and athletes. Overall, De Quervain’s tendinosis is a treatable condition with a good prognosis, particularly when diagnosed and treated early.

What causes de Quervain’s tendinosis?

De Quervain’s tendinosis is caused by irritation and inflammation of the tendons that run through a tunnel on the thumb side of the wrist. The exact cause of this inflammation is not fully understood, but it is often related to overuse or repetitive strain on the tendons. Repetitive motions that involve gripping, twisting, or pinching can cause microscopic tears in the tendons, leading to inflammation and pain. This condition is more common in women than men, and is often associated with pregnancy and caring for young children, which can involve repetitive lifting and holding of the baby. Other risk factors for developing De Quervain’s tendinosis include age, certain medical conditions such as rheumatoid arthritis, and previous injury or trauma to the wrist or thumb. In some cases, the condition may be related to anatomical factors such as a thickened or enlarged first dorsal compartment, which can cause compression of the tendons.

What are the symptoms of de Quervain’s tendinosis?

The most common symptoms of De Quervain’s tendinosis are pain and tenderness on the thumb side of the wrist, which may radiate up the forearm. The pain may be sharp or aching, and is often worsened by gripping, pinching, or twisting motions, as well as when making a fist or grasping objects. In some cases, there may be swelling and a “creaking” or “grinding” sensation when moving the thumb or wrist. The affected thumb may also feel weak, making it difficult to perform everyday activities that involve gripping or holding objects, such as turning a doorknob or opening a jar. In severe cases, the pain may be constant and affect the ability to perform even simple tasks. It is important to seek medical attention if you experience any of these symptoms, as early diagnosis and treatment can help prevent the condition from worsening and improve your chances of a full recovery.

How is de Quervain’s tendinosis diagnosed?

De Quervain’s tendinosis is typically diagnosed based on a combination of medical history, physical examination, and imaging tests. During the physical examination, the healthcare provider will ask about the symptoms, perform a detailed examination of the affected wrist and thumb, and assess range of motion and strength. The provider may also perform specific tests to check for tenderness over the affected tendons and to evaluate for the presence of crepitus, or a creaking or grinding sensation.

Imaging tests such as X-rays or ultrasound may also be ordered to evaluate the affected area and rule out other conditions, such as a fracture or arthritis. An ultrasound is particularly useful in detecting inflammation and swelling of the tendons, which can help to confirm the diagnosis of De Quervain’s tendinosis.

In some cases, a specialized test called a Finkelstein test may be performed. This test involves bending the thumb across the palm and bending the wrist towards the little finger, which can elicit pain if the tendons are inflamed. However, this test alone is not sufficient to make a diagnosis, and imaging tests are often needed to confirm the diagnosis and rule out other conditions.

How is de Quervain’s tendinosis treated?

De Quervain’s tendinosis can be treated with both non-surgical and surgical approaches, depending on the severity of the condition and the response to conservative treatment. Non-surgical treatment options include:

1-Rest: Resting the affected wrist and avoiding repetitive movements can help to reduce inflammation and relieve symptoms.

2-Immobilization: Wearing a wrist splint or brace can help to immobilize the affected area and reduce stress on the tendons.

3-Ice therapy: Applying ice to the affected area can help to reduce inflammation and relieve pain.

4-Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can help to reduce pain and inflammation.

5-Physical therapy: Stretching and strengthening exercises can help to improve range of motion and reduce symptoms.

6-Corticosteroid injections: Injecting corticosteroids into the affected area can help to reduce inflammation and relieve pain.

Surgical treatment may be considered in cases where conservative treatment fails to provide relief, or if the condition is severe. The surgery involves making a small incision over the affected tendon compartment and releasing the constricting tendon sheath to allow more room for the tendons to move freely.

Overall, the prognosis for De Quervain’s tendinosis is generally good, and most patients experience significant improvement with conservative treatment. However, the condition can recur if the underlying causes, such as repetitive movements or anatomical factors, are not addressed.

Can de Quervain’s tendinosis be prevented?

De Quervain’s tendinosis may be preventable in some cases. Here are some tips that may help reduce the risk of developing this condition:

1-Take frequent breaks: If you engage in repetitive hand or wrist movements, take frequent breaks to rest and stretch your muscles and tendons.

2-Use proper technique: When performing tasks that require repetitive hand or wrist movements, use proper technique to minimize stress on the tendons. For example, use your whole hand to grasp objects, rather than just your fingers or thumb.

3-Use ergonomic tools: Ergonomic tools, such as keyboards, mice, and wrist rests, can help reduce stress on the tendons and improve overall wrist and hand posture.

4-Exercise regularly: Regular exercise can help improve flexibility and strength in the muscles and tendons of the hand and wrist, reducing the risk of injury.

5-Avoid repetitive wrist movements: Avoid repetitive movements of the wrist, such as prolonged computer mouse use, or gripping and twisting motions.

6-Use splints: Consider using a wrist splint or brace, especially during activities that involve repetitive hand or wrist movements.

7-Maintain a healthy weight: Excess weight can increase stress on the joints, including those in the hand and wrist, which may increase the risk of developing De Quervain’s tendinosis.

It is important to note that some factors, such as anatomical variations or medical conditions, may increase the risk of developing this condition, and may be beyond your control. However, adopting healthy lifestyle habits and taking preventive measures can help reduce the risk of developing De Quervain’s tendinosis.

What is the outlook for de Quervain’s tendinosis?

The outlook for de Quervain’s tendinosis is generally good, with most people experiencing significant improvement in their symptoms with appropriate treatment. Non-surgical treatment options, such as rest, immobilization, ice therapy, physical therapy, medications, and corticosteroid injections, can provide relief for many patients.

In cases where conservative treatment fails to provide relief, surgery may be necessary. Surgical treatment involves releasing the constricting tendon sheath to allow more room for the tendons to move freely, and is usually successful in relieving symptoms.

However, it is important to note that even after successful treatment, de Quervain’s tendinosis can recur if the underlying causes, such as repetitive movements or anatomical factors, are not addressed. Therefore, it is important to take preventive measures, such as taking frequent breaks, using proper technique, using ergonomic tools, and maintaining a healthy weight, to reduce the risk of recurrence.

Overall, with proper treatment and preventive measures, most people with de Quervain’s tendinosis can expect to manage their symptoms effectively and maintain good hand and wrist function.