Anatomy of the Tendons of the Hand
The muscles and bones of the hand are connected by thick flexible tissue called tendons. Tendons are covered by a thin, soft sheath of tissue known as synovium. Extensor pollicis brevis and abductor pollicis longus are two tendons located on the thumb side of the wrist.
What is DeQuervain’s Tendonitis?
Inflammation and swelling of the tendon sheath(s) may cause pain on the thumb side of the wrist. Strain on these tendons can cause swelling and irritation, and lead to a condition called DeQuervain’s tenosynovitis. The condition is also referred to as DeQuervain’s tendinitis, DeQuervain’s tendinosis, DeQuervain’s syndrome, or DeQuervain’s disease.
Causes of DeQuervain’s Tendonitis
The exact cause of DeQuervain’s tenosynovitis is unknown, but is usually seen in individuals with repetitive hand or wrist movements, injury to the wrist or tendon, and inflammatory conditions such as rheumatoid arthritis or inflammatory arthritis. De Quervain’s tenosynovitis is most common in pregnant and middle-aged women.
Signs and Symptoms of DeQuervain’s Tendonitis
The symptoms of DeQuervain’s tenosynovitis include pain and tenderness on the side of the wrist at the base of the thumb. There may also be swelling and redness in the area. Symptoms may be made worse while making a fist, grasping or gripping objects, or turning the wrist. A “catching” or “snapping” sensation while moving the thumb may also be present.
Diagnosis of DeQuervain’s Tendonitis
DeQuervain’s tenosynovitis is diagnosed by observing symptoms, patient medical history and performing a physical examination of the wrist. De Quervain’s tenosynovitis can be confirmed through the Finkelstein test. For this test, your doctor will ask you to make a fist with your fingers covering the thumb, and bend the wrist towards your little finger. Pain during this movement will confirm the condition.
Treatment for DeQuervain’s Tendonitis
The treatment of DeQuervain’s syndrome consists of both non-surgical and surgical therapy.
Non-surgical therapy includes avoiding activities that increase pain and swelling, applying ice, using a splint to support and immobilize the hand, and medicines. Anti-inflammatory medicines are helpful in relieving pain and swelling. Your physician may also recommend a corticosteroid injection to reduce the swelling of the tendon sheath.
Your physician will recommend surgery based on the severity of your pain symptoms and response to non-surgical treatment methods. The outpatient surgical procedure involves opening or cutting the inflamed region of the tendon sheath to relieve the pressure on the tendon and allow free movement of the wrist.