De Quervain's Tenosynovitis

Pain at the side of the wrist beneath the base of the thumb is a symptom of de Quervain's tenosynovitis.

De Quervain's tenosynovitis is inflammation of tendons on the side of the wrist at the base of the thumb. These tendons include the extensor pollicis brevis and the abductor pollicis longus tendons, which extend the joints of the thumb.

De Quervain's tenosynovitis can be brought on by simple strain injury to the extensor pollicis longus and abductor pollicis tendons (tendinitis). Often this form of tendinitis is a result of repetitive motion injury. Typical causes of de Quervain's tenosynovitis include stresses such as lifting young children into car seats, lifting heavy grocery bags by the loops, and lifting gardening pots up and into place.

Risk factors for de Quervain's tenosynovitis include the following:

• Being female
• Age over 40
• African ethnicity/descent
• Pregnancy

De Quervain's tenosynovitis causes symptoms of pain and tenderness at the side of the wrist beneath the base of the thumb. Sometimes there is slight swelling and redness in the area.

De Quervain's tenosynovitis is diagnosed based on the typical appearance, location of pain, and tenderness of the affected wrist. De Quervain's tenosynovitis is usually associated with pain when the thumb is folded across the palm and the fingers are flexed over the thumb as the hand is flexed down toward the little finger away from the involved wrist area. (This is referred to as the Finkelstein maneuver.) X-rays and other imaging tests are usually not needed to diagnose de Quervain's tenosynovitis.

De Quervain's tenosynovitis is commonly diagnosed and treated by primary care physicians (PCPs), including general practitioners, family medicine physicians, and internists. Specialists who treat de Quervain's tenosynovitis include orthopedic surgeons, sports-medicine doctors, and rheumatologists. Occupational therapists and physical therapists can be involved in the care of patients with de Quervain's tenosynovitis.

Treatments for de Quervain's tenosynovitis includes any combination of rest, splinting, ice, anti-inflammation medication, and/or cortisone injection. Cortisone injection is extremely effective and is generally the optimal treatment. Normal activity may be resumed within three weeks after an injection. Surgery to release the tendon sheath is only rarely necessary and usually reserved for persisting inflammation after failure of at least one cortisone injection.

De Quervain's tenosynovitis can initially be treated with home remedies, including cold packs, resting, and over-the-counter medications, such as ibuprofen (Motrin, Advil) and naproxen (Aleve). Care must be taken to avoid reinjuring the strained tendon at the wrist. For example, young mothers must be very careful about lifting their children without straining the involved side of the wrist.

The prognosis for de Quervain's tenosynovitis is excellent. The patient can generally return to full function after the inflammation quiets down with treatment. Sometimes bracing is used during future activities that involve repetitive wrist motion.

De Quervain's tenosynovitis can be prevented by avoiding activities that stress the wrist and avoiding repetitive motion injuries.