de Quervain’s Tenosynovitis

De Quervain's tenosynovitis is a condition characterized by pain and inflammation in the tendons on the thumb side of your wrist. These tendons, known as the abductor pollicis longus (APL) and the extensor pollicis brevis (EPB), are responsible for the movement of the thumb and wrist. They run through a tunnel-like structure called a sheath, which can sometimes become narrow or constrict the tendons, leading to the symptoms of de Quervain's tenosynovitis. This sheath is known as the “first extensor compartment”. This condition can cause discomfort when turning your wrist, grasping objects, or making a fist. It is particularly common in individuals who perform repetitive movements with their hands and wrists, such as new mothers, and those with certain medical conditions like rheumatoid arthritis.

The diagnosis of de Quervain's tenosynovitis is typically based on the history of the patient's symptoms and a physical examination. A common diagnostic test is the Finkelstein test, which involves bending your thumb across the palm of your hand, bending your fingers down over your thumb, and then bending your wrist towards your little finger. If this action causes pain on the thumb side of your wrist, it is likely you have de Quervain's tenosynovitis. In addition to the Finkelstein test, your doctor may also examine your wrist for swelling and tenderness, and ask about any activities that could be causing your symptoms.

The primary goal of treatment for de Quervain's tenosynovitis is to reduce inflammation, alleviate pain, and restore normal function to the thumb and wrist. The treatment approach often depends on the severity of the condition and the patient's individual needs. Here are some common treatment options:

1. Medications: Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen can help reduce inflammation and relieve pain. Topical medications like Voltaren gel can also be applied directly to the area to alleviate symptoms.

2. Corticosteroid Injections: If the symptoms are severe or do not improve with medications, a corticosteroid injection may be helpful. These injections can significantly reduce inflammation and provide relief from pain.

3. Rest and Splinting: Avoiding activities that exacerbate the pain and swelling can allow the symptoms to resolve on their own. A removable splint that keeps the wrist and thumb immobilized, known as a “thumb spica splint”, can also provide relief. There are over the counter versions that can be purchased or custom splints that can be made by hand therapists. Typically, this splint should be hard so that it limits movement of the thumb and wrist, and it should be worn at all times, including while sleeping. This helps to rest the involved tendons to decrease the inflammation.

4. Surgery: In cases where non-operative treatments do not provide relief, surgery may be considered. The surgical procedure involves opening the sheath that houses the inflamed tendons to create more room, thereby reducing the constriction and inflammation. This procedure can effectively alleviate the symptoms of de Quervain's tenosynovitis without affecting the function of the hand or wrist. Because of the particular anatomy in this region, it is important to have an experienced hand surgeon who regularly performs this procedure in order to decrease the risk of complications, including nerve injury, and to increase the likelihood of a successful recovery.

The recovery time after treatment for de Quervain's tenosynovitis varies depending on the severity of the condition and the type of treatment used. For non-surgical treatments, most people experience significant improvement within four to six weeks. Full recovery from surgery can take a few weeks to a few months.

Be sure to see an experienced surgeon to treat this condition. Our fellowship-trained specialists at The Buncke Clinic in San Francisco treat patients with de Quervain's tenosynovitis from across the Bay Area and Northern California. Contact us to schedule a consultation.

Below are links for third party resources

American Society for Surgery of the Hand

American Academy of Orthopaedic Surgeons