De Quervain’s Tendinitis
Named for the Swiss surgeon who identified this disorder in 1895, De Quervain’s Tendinitis occurs when the tendons that stretch across the base of the thumb become inflamed or constricted, usually due to overuse. While pregnancy can be another cause for this condition, it is most often seen in middle-aged women. It can also be seen in people who have inflammatory diseases, such as rheumatoid arthritis.
When the tendon, on the thumb side of the wrist, becomes irritated, it causes the synovium (a thin, slippery coating around the tendons, which helps them glide smoothly) to swell. The tendons move through a sheath in the wrist and this swelling makes it difficult for the tendons to move through the sheath smoothly. They can even snap or pop, as they move through the restricted sheath space, due to the swelling. This swelling will also impinge on the nerves in the thumb and index fingers, causing numbness and pain.
Symptoms of De Quervain’s are:
- Pain at the base of the thumb at the wrist
- Swelling at the base of the thumb at the wrist
- Pain when grasping, twisting or closing the hand
- Pain can appear suddenly or over time
- Can be accompanied by the presence of a fluid-filled cyst
- Numbness in the thumb
- Referred pain into the forearm
- Snapping or catching of the tendon
The diagnosis is made by listening to the patient symptoms and by performing a simple test, called the Finkelstein test, where the patient closes their fingers over their thumb and bends the wrist toward the little finger. If a person has De Quervain’s, they usually will find this test to be quite uncomfortable. Neither X-rays nor MRI are needed to diagnose De Quervain’s tendinitis.
Treatment of De Quervain’s is most often done conservatively at first. Activity modification and rest, OTC anti-inflammatory, such as Aleve or Ibuprofen and an application of ice to the area intermittently.
If the patient tries this at home and sees no improvement, a corticosteroid injection to help reduce the inflammation and pain. Usually, these treatments will alleviate the problem after a few months.
For more recalcitrant cases, Physical Therapy may be prescribed to help strengthen other muscles around the inflamed tendon and to help the patient relearn how to perform the activities aggravating the tendon. The Physical Therapist also can perform other modalities to reduce inflammation, such as laser therapy, application of heat, use of a TENS unit, treatment with cold packs and other therapies. A brace can also be prescribed for the patient that will allow their thumb and wrist to rest and heal.
Rarely, the patient will not improve and their symptoms will only worsen. In that case, surgery is recommended to open the sheath through which the inflamed tendons must travel. By doing so, the tendons are given more room to move, which reduces the irritation generated by their constant friction against the sheath. Surgery for De Quervain’s is performed as outpatient surgery and is a quick and simple procedure.
There are always risks to surgery, including infection or damage to the radial sensory nerve. It is important to discuss these risks with your Orthopaedic specialist before having surgery.
For some individuals, symptom resolution may take up to a year and many patients become impatient and opt for surgery, when they would have eventually improved with time.