De Quervain’s Tenosynovitis

De Quervain’s tenosynovitis is a painful condition on the thumb side of the wrist. It is not necessarily caused by significant strain or trauma. This type of condition is often found in patients whose activities require repetitive movements. The pain arises when you pick something up (even something light) or when making a fist. The thumb may also feel stiff or “stuck.”

What exactly is happening?

This is an irritation of the tendons of the thumb, whether the short extensor or the long abductor. A fibrous sheath envelops these two tendons, leaving little space between them and encouraging greater friction. This condition is the result of repeated micro-traumas to the thumb in the context of office work or meticulous manual tasks.

What symptoms might indicate to me that I have this condition?

• Intense, localized pain on the side of the wrist, limiting movement.
• Gradual appearance over the course of a few weeks.
• Significant limitation of thumb movement.
• Pain may spread to the forearm.
• Touching the other fingers with the thumb and turning the wrist in the direction of the little finger is difficult and painful, because it makes the irritated tendons tense.

Are there tests I can take to make my diagnosis “official”?

Traditional X-rays generally show no abnormality. An ultrasound may confirm inflammation of the affected tendons, but this is not required for treatment.

Is this treatable?

This condition sometimes heals on its own, but generally only after 6 to 18 months of constant pain, causing considerable disability, even the cessation of all professional and daily activities.

The first step is to stop the activity that is causing the condition. Taking anti-inflammatory medication and applying ice can help to lessen the inflammation. A partial or complete break from the activity may be necessary. The use of a splint can be a great way to continue engaging in some activities without irritating the thumb.

Conservative physical therapy treatments can speed up healing, thus reducing the risk of compensation, recurrence, and long-term consequences. The traditional physical therapy treatments are as follows:

• Mobilization of the bones of the thumb and wrist
• Hand and forearm muscle techniques
• Ultrasound (to reduce inflammation and aid in tissue healing)
• Taping
• Prescription of exercises to mobilize and strengthen the hand, wrist, and elbow.

In most cases, surgery is not even considered. But for persistent cases, local cortisone injections are sometimes recommended in combination with physical therapy treatments.