De Quervian’s Tenosynovitis: What is it and how can you treat it?
De Quervain’s Tenosynovitis is a painful condition that affects the tendons on the thumb side of your wrist. If you’ve ever felt pain when gripping, pinching, or even turning your wrist, you could be experiencing this condition – however other wrist issues present with similar symptoms, and so we go into further detail below.
What is De Quervain’s Tenosynovitis?
Named after Swiss surgeon Fritz de Quervain, De Quervain’s Tenosynovitis is one of the most common causes of wrist pain, particularly in those who perform repetitive hand movements. The condition occurs when the tendons that run from the wrist to the thumb become irritated or inflamed. These tendons run through a sheath, and inflammation causes swelling, which restricts movement and leads to pain. The inflammation also thickens the sheath, creating friction when you move your thumb and wrist. This condition typically affects the two main tendons controlling thumb movement – the abductor pollicis longus (APL) and the extensor pollicis brevis (EPB).
Reproduced via OrthoInfo from: Griffin LY (ed): Essentials of Musculoskeletal Care, 3rd Edition. Rosemont, IL. American Academy of Orthopaedic Surgeons, 2005
Symptoms of De Quervain’s Tenosynovitis
The primary symptom is pain (either gradual or sudden) and tenderness on the thumb side of the wrist. However, the pain can spread up the forearm or down into the thumb, making gripping, pinching, or other hand movements uncomfortable.
Additional symptoms include:
Swelling near the base of the thumb
A “sticking” or “snapping” sensation when moving the thumb
The pain is often worsened by activities involving repetitive wrist and thumb movements, such as writing, lifting, or turning doorknobs.
Causes and Risk Factors
The exact cause of De Quervain’s Tenosynovitis isn’t always clear, but repetitive hand movements are a significant contributor. Activities like lifting a child, knitting, playing sports, or even excessive smartphone use can strain the thumb tendons over time. New mothers are particularly prone to this condition due to the repetitive motion of lifting and carrying their babies.
Other risk factors include:
Age and Gender: Women between 30 and 50 years old are more commonly affected.
Injury: A wrist injury can lead to scar tissue, which may restrict movement and contribute to this condition.
Arthritis: Conditions like rheumatoid arthritis can increase the risk of developing De Quervain’s.
Diagnosing De Quervain’s Tenosynovitis
Diagnosis is usually straightforward and involves a physical examination. Your doctor may perform a Finkelstein test, where you’ll be asked to make a fist with your thumb tucked inside your fingers. If this manoeuvre causes pain on the thumb side of your wrist, it’s a strong indication of De Quervain’s.
Adapted via OrthoInfo from the American Society for Surgery of the Hand: Brochure: de Quervain's Stenosing Tenosynovitis. Engelwood, CO, 1995
Treatment Options
Treatment depends on the severity of the condition but often begins with non-surgical options:
Rest and Immobilisation: Wearing a splint to keep the wrist and thumb immobilized can give the tendons time to heal.
Ice and Pain Relief/Anti-Inflammatory Medications: Applying ice and taking over-the-counter medications like paracetamol and ibuprofen can help reduce swelling and pain.
Physical Therapy: Stretching and strengthening exercises can help improve flexibility and reduce pain.
Steroid and Prolozone Injections
In addition, a steroid injection, also known as corticosteroid, is a potent anti-inflammatory and is very effective at reducing the pain and swelling associated with the condition. The steroid is combined with a local anaesthetic to ensure the procedure is relatively pain-free, and is carried out using ultrasound guidance to ensure the needle is placed in the correct place to get maximal pain relief.
Following the injection, the majority of patients will experience a significant reduction in their symptoms within just a few days, however, it is vitally important that an injection is followed by a period of physiotherapy rehabilitation. As symptoms begin to settle then rehabilitation of the wrist and hand can start.
Prolozone injections are also an option. A mixture of ozone gas and nutrients are injected into the affected area and together these therapies promote healing and tissue regeneration, providing relief from pain and improving mobility.
If conservative treatments don’t provide relief, surgery might be considered. The surgical procedure involves releasing the tendon sheath to relieve pressure and allow freer movement.
De Quervain’s Tenosynovitis can be a frustrating and painful condition, but with early intervention and appropriate treatment, most people experience significant relief.
50% to 80% of patients can be successfully treated non-surgically with splints, NSAIDs, and injections. The remaining patients typically respond well to surgery.
If you’re struggling with persistent wrist pain, it’s essential to seek medical advice early. Proper diagnosis and treatment can help you return to your daily activities without discomfort and prevent the condition from worsening.
The Leigh Injection Clinic offer both steroid injections and prolozone injections to treat many different MSK related pains – including De Quervain’s Tenosynovitis. For more information please take a look at the website.
The Leigh Injection Clinic are based on the coast in Leigh on Sea, Essex – perfect for patients in Essex, Kent, London, and surrounding areas.
https://www.leighinjectionclinic.co.uk
https://www.bssh.ac.uk/patients/conditions/19/de_quervains_syndrome