What is de Quervain’s Tenosynovitis?

De Quervain’s tenosynovitis is a condition that affects two tendons in the thumb, namely the abductor pollicis longus (APL) and the extensor pollicis brevis (EPB). These tendons pass through a tunnel located near the end of the radius bone of the forearm. The tunnel acts like a guide to hold the tendons in place and is lined with a slippery coating called tenosynovium, which allows the tendons to glide smoothly back and forth as they move the thumb.

Tenosynovitis refers to inflammation of the tenosynovium and tendon. In de Quervain’s tenosynovitis, there is non-inflammatory thickening of the tendons, which constricts their movement within the tunnel, causing irritation. This results in pain and tenderness on the thumb side of the wrist, which may be aggravated by thumb and wrist movements.

Causes of de Quervain’s Tenosynovitis

De Quervain’s tenosynovitis can be caused by repeated hand and thumb motions, such as grasping, pinching, squeezing, or wringing, which can lead to inflammation of the tenosynovium and tendons. This inflammation can cause swelling, which restricts the smooth gliding action of the tendons within the tunnel. Scar tissue from an injury can also make it difficult for the tendons to slide easily through the tunnel.

Arthritic diseases that affect the whole body, such as rheumatoid arthritis, can also cause tenosynovitis in the thumb. Other factors that may increase the risk of developing de Quervain’s tenosynovitis include hormonal changes during pregnancy or breastfeeding, and certain medical conditions such as diabetes and thyroid disease.

In some cases, the cause of de Quervain’s tenosynovitis is unknown, and the pain may occur without any apparent direct mechanism or unusual activity.

Symptoms of de Quervain’s Tenosynovitis

The symptoms of de Quervain’s tenosynovitis typically start as soreness on the thumb side of the forearm, near the wrist. If left untreated, the pain may spread up the forearm or further down into the wrist and thumb. As the condition worsens, the tendons may begin to creak as they move through the constricted tunnel, resulting in a noise called crepitus. Swelling may also occur along the tunnel near the edge of the wrist.

Grasping objects with the thumb and hand may become increasingly painful, and the affected area may feel tender to the touch. In some cases, a lump may develop at the base of the thumb. Activities that involve repetitive hand and thumb motions, such as typing, knitting, or playing an instrument, may exacerbate the pain and discomfort.

de Quervain’s Tenosynovitis Diagnosis

Diagnosing de Quervain’s tenosynovitis relies on symptoms and physical exam. Imaging usually isn’t necessary. The Finkelstein test is a reliable diagnostic tool. A healthcare professional should perform the test. Other conditions can cause similar symptoms, so a proper diagnosis is essential.

Treatment of de Quervain’s Tenosynovitis

Treatment of de Quervain’s tenosynovitis usually involves a combination of rest, splinting, and physiotherapy. In some cases, glucocorticoid injections may also be used. Here are some ways to treat this condition:

Rest or Reduce Hand Movements

It’s important to avoid activities that cause pain or discomfort. Taking frequent breaks when doing repeated hand and thumb actions can help. Avoid repetitive hand motions, such as heavy grasping, wringing, or turning and twisting wrist movements. Keeping the wrist in a neutral alignment can also help. In other words, keep it in a straight line with your arm, without bending it forward or backward.

Thumb-Spica Splint

Wearing a forearm and thumb splint called a thumb spica splint can help to immobilise the wrist and lower joints of the thumb. The brace allows the APL and EPB tendons to rest, giving them a chance to begin to heal.

Glucocorticoid Injections

A glucocorticoid injection administered between the two painful APL and EPB tendons may provide symptomatic relief of de Quervain’s tenosynovitis. The combined use of splints and glucocorticoid injections is more beneficial than just splinting alone. However, de Quervain’s tenosynovitis is rarely a longstanding injury.

Physiotherapy

The main focus of physiotherapy is to reduce or eliminate the cause of irritation of the thumb tendons. Your physiotherapist may check the way you do your work tasks and suggest healthy body alignment and wrist positions, supports, helpful exercises, and tips on preventing future problems.

Your physiotherapist may use ice packs, soft-tissue massage, and hands-on stretching to settle the condition and restore any lost range of motion. Strengthening your hand and thumb may involve using handy products such as hand eggs or exercise putty. Therapists also use a series of gentle stretches to encourage the thumb tendons to glide smoothly within the tunnel.

As you progress, your therapist will give you exercises to help strengthen and stabilise the muscles and joints in the hand and thumb. Some of the exercises you’ll do will be similar to your work tasks and sports activities. Your therapist will help you find ways to do your tasks that don’t put too much stress on your thumb and wrist. Before your therapy sessions end, your therapist will teach you several ways to avoid future problems.

For specific advice regarding your de Quervain’s tenosynovitis, please consult your hand physiotherapist or doctor.