De Quervain tenosynovitis

De Quervain tenosynovitis (dih-kwer-VAIN ten-oh-sine-oh-VIE-tis) is a painful condition that affects the tendons on the thumb side of the wrist. If you have de Quervain tenosynovitis, you typically feel pain when you turn your wrist, grip something or make a fist.

The exact cause of de Quervain tenosynovitis isn't known. But activities that involve repeating the same hand or wrist movements can make the condition worse. For example, gardening, playing golf or racket sports, and lifting a baby can make it worse.

Symptoms of de Quervain tenosynovitis include:

• Pain near the base of the thumb.
• Swelling near the base of the thumb.
• Trouble moving the thumb and wrist when gripping or pinching.
• A sticking or catching feeling when you move your thumb.

If not treated, the pain may spread into the thumb, forearm or both. Moving the thumb or wrist may make the pain worse.

When to see a doctor

Talk to your healthcare professional if you're still having pain or trouble using your thumb after trying the following:

• Resting your thumb and avoiding activities that cause pain.
• Applying ice or a cold pack to the area. Always put a thin cloth between your skin and ice.
• Taking pain medicine you can buy without a prescription, such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve). These are types of nonsteroidal anti-inflammatory medicines, also called NSAIDs.

De Quervain tenosynovitis affects the two tendons on the thumb side of the wrist. Tendons are rope like tissues that connect muscles to bones.

Doing the same hand movements over and over — such as lifting, gripping or twisting — can irritate the protective covering around these tendons. When this covering is irritated, the tendons may swell and thicken. This makes it harder for them to slide smoothly through the small tunnel that connects them to the base of the thumb.

Other causes of de Quervain tenosynovitis include:

• Inflammatory arthritis, such as rheumatoid arthritis.
• Injury to the wrist or tendons, which may lead to scar tissue that limits tendon movement.
• Fluid buildup, often caused by hormone changes during pregnancy.

Risk factors for de Quervain tenosynovitis include:

• Age. People ages 30 to 50 are at higher risk.
• Sex assigned at birth. Women are more likely to develop this condition than men.
• Pregnancy and breastfeeding. It may be linked to being pregnant and to breastfeeding.
• Caring for a baby. Repeatedly lifting a child, especially using your thumbs for support, may increase the risk.
• Repetitive hand or wrist movements. Jobs or hobbies that involve doing the same motions over and over — such as typing, gardening or playing certain sports — can contribute to the condition.

If de Quervain tenosynovitis isn't treated, it can become hard to use your hand and wrist as you'd like. You may lose some range of motion in your wrist.

To diagnose de Quervain tenosynovitis, your healthcare professional checks your hand and presses on the thumb side of your wrist to see if it causes pain.

Tests

You may be asked to do a Finkelstein test. This involves bending your thumb across your palm, then folding your fingers over your thumb. Next, you bend your wrist toward your little finger. If this movement causes pain on the thumb side of your wrist, it's likely that you have de Quervain tenosynovitis.

Imaging tests, such as X-rays, generally aren't needed to diagnose this condition.

Treatment for de Quervain tenosynovitis focuses on reducing inflammation, keeping the thumb still in a comfortable position and preventing the condition from coming back.

If treatment begins early, symptoms typically improve within 4 to 6 weeks. If de Quervain tenosynovitis starts during pregnancy, symptoms typically go away by the end of pregnancy or after breastfeeding ends.

Medications

To reduce pain and swelling, your healthcare professional may recommend using pain relievers that you can buy without a prescription. These include ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve).

Your healthcare professional also may recommend a corticosteroid injection into the tissue covering the tendon to lessen inflammation. If treatment starts within the first six months of symptoms, most people recover fully — often after just one injection.

Therapies

Treatment of de Quervain tenosynovitis typically includes:

• Wearing a splint or brace to keep your thumb and wrist straight. This allows the tendons to rest.
• Avoiding repetitive thumb movements as much as possible.
• Not pinching or gripping with your thumb while moving your wrist side to side.
• Applying ice to the painful area to lessen swelling and pain.

You also may work with a physical therapist or occupational therapist. The therapist can look at how you use your wrist and suggest ways to reduce strain. They also can teach you exercises to strengthen your wrist, hand and arm muscles. This may relieve pain and prevent further irritation of the tendons.

Surgery or other procedures

Surgery may be recommended if the condition is more serious or doesn't improve with other treatments. It typically is done as an outpatient procedure, meaning you go home the same day. During surgery, the doctor looks at the protective covering around the affected tendon or tendons and carefully opens the covering. This relieves pressure and allows the tendons to move more freely.

After surgery, ask your healthcare team how long you need to rest. Ask how you can strengthen and take care of your wrist after surgery. A physical therapist or an occupational therapist may meet with you after surgery. They teach you exercises and show you how to adjust back to your daily activities to help prevent de Quervain tenosynovitis from coming back.

If you don't need surgery, managing de Quervain tenosynovitis is much the same as preventing it:

• Avoid repeating the same wrist movements over and over.
• Wear a brace or splint if your healthcare professional tells you to.
• Keep up with any exercises you are told to do.
• Pay attention to activities that cause pain, swelling or numbness in your thumb or wrist. Try to avoid these activities, and tell your healthcare professional what triggers your symptoms.

Make an appointment with your healthcare professional if you have hand or wrist pain that doesn't improve after avoiding activities that make it worse. After the first exam, you may be referred to a specialist, such as an orthopedist, rheumatologist, hand therapist or occupational therapist.

Here's some information to help you get ready for your appointment.

What you can do

• Write down important medical information, including other health conditions you have and all medicines and supplements you take.
• List any hobbies or activities that may put stress on your hand or wrist, such as knitting, gardening, playing an instrument, playing racket sports and performing repetitive work tasks.
• Note any recent injuries to your hand or wrist.
• Write down a list of questions to ask your healthcare professional.

Here are some helpful questions to ask the healthcare professional who evaluates you for wrist or hand symptoms:

• What is the most likely cause of my symptoms?
• Are there any other possible causes?
• Do I need tests to confirm the diagnosis?
• What treatment do you recommend?
• I have other health conditions. How can I best manage these conditions together?
• Will I need surgery?
• How long will I need to avoid the activities that may have caused this?
• What can I do on my own to improve my condition?

Don't hesitate to ask other questions as well.

What to expect from your doctor

If you're being seen for symptoms that may be related to de Quervain tenosynovitis, your healthcare professional may ask you questions such as:

• What are your symptoms and when did they start?
• Are your symptoms getting worse or staying the same?
• Are there any specific activities that seem to trigger your symptoms?
• Do you take part in any hobbies or sports that involve repeated hand or wrist movements?
• What tasks do you do at work?
• Have you had any recent injuries to your hand or wrist?
• Does avoiding certain activities relieve your symptoms?
• Have you tried any home treatments, such as pain relievers you can buy without a prescription? If so, what has and hasn't worked?