De Quervain Tenosynovitis

Overview

De Quervain tenosynovitis is a painful condition that affects the tendons on the thumb side of the wrist. It is characterized by pain and discomfort when turning the wrist, grasping objects, or making a fist. The exact cause of de Quervain tenosynovitis is not known, but it can be worsened by repetitive hand or wrist movements, such as those involved in working in the garden, playing racket sports, or lifting a baby.

Understanding the disease

Risk Factors

Risk factors for developing de Quervain tenosynovitis include:

1. Age: People between the ages of 30 and 50 have a higher risk of developing the condition than those in other age groups, including children.
2. Sex: The condition is more common in women.
3. Pregnancy: The condition may be associated with pregnancy.
4. Repetitive hand and wrist motions: Engaging in jobs or hobbies that involve repetitive hand and wrist motions can contribute to developing de Quervain tenosynovitis.
5. Chronic overuse: Repeating a particular hand motion day after day can irritate the covering around the tendons, leading to the condition.
6. Inflammatory arthritis: Inflammatory arthritis, such as rheumatoid arthritis, can also cause de Quervain tenosynovitis.
7. Direct injury to the wrist or tendon: Such injury can result in scar tissue that restricts the movement of tendons.
8. Fluid retention: Changes in hormones during pregnancy may cause fluid retention, which can contribute to the development of de Quervain tenosynovitis.

Development

De Quervain tenosynovitis develops as a result of repetitive hand or wrist movements, which can lead to chronic overuse, irritation, thickening, and swelling of the tendons on the thumb side of the wrist. This condition can be associated with various factors, including age, sex, pregnancy, and specific jobs or hobbies that involve repetitive hand and wrist motions. In some cases, de Quervain tenosynovitis can be caused by direct injury to the wrist or tendon, fluid retention, or inflammatory arthritis such as rheumatoid arthritis.

Assessment and Diagnosis

Diagnosis

To diagnose de Quervain tenosynovitis, a healthcare provider will examine your hand for pain when pressure is applied on the thumb side of the wrist. They may also ask you to perform the Finkelstein test, bending your thumb across the palm of your hand, bending your fingers down over your thumb, and bending your wrist toward your little finger. If this causes pain on the thumb side of your wrist, it's likely de Quervain tenosynovitis. Imaging tests like X-rays are generally not needed for diagnosis.

Management and Treatment

Treatment

Treatments for de Quervain tenosynovitis typically involve a combination of rest, ice, and physical therapy exercises to reduce pain and inflammation. In some cases, medication and splinting may also be recommended. If the condition is severe, surgery may be necessary. Here are some common treatment options:

1. Rest: Avoid activities that worsen the pain or require repetitive hand or wrist movements. Take breaks and rest your wrist to allow it to recover.
2. Ice: Apply ice to the affected area for 15-20 minutes, three to four times a day. This can help reduce pain and inflammation.
3. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Over-the-counter NSAIDs like ibuprofen and naproxen sodium can help alleviate pain and reduce inflammation.
4. Splinting: Your healthcare provider may recommend wearing a splint to help keep your wrist in a neutral position and reduce strain on the tendons.
5. Physical therapy: A physical therapist can help you perform exercises to strengthen your wrist and forearm muscles, improve flexibility, and reduce pain.
6. Corticosteroid injections: In some cases, a corticosteroid injection may be offered to reduce pain and inflammation.
7. Surgery: If more conservative treatments do not provide relief, surgery may be considered to release the tendons from the inflamed sheath. It's essential to consult your healthcare provider for an appropriate diagnosis and personalized treatment plan.

Preparing for medical consultation

Here are some steps to help you prepare for an appointment for de Quervain tenosynovitis:

1. Review the pre-appointment restrictions: When you schedule the appointment, ask if there are any restrictions you need to follow in the time leading up to your visit, such as avoiding strenuous activities or taking specific medications.
2. Gather your symptom history: Write down any symptoms you've been experiencing, including pain, swelling, numbness, or weakness in your wrist or thumb, and when they began. Be specific and detailed in describing your symptoms.
3. Recall recent exposure to possible sources of infection: Your doctor will be interested to know if you have recently engaged in activities that may have caused repetitive motions or strain to your wrist, such as prolonged use of a mouse or keyboard, playing musical instruments, or lifting heavy objects.
4. Bring your vaccination record: Find out before your appointment whether your vaccinations are up to date. If possible, bring a copy of your vaccination record to share with your doctor.
5. List your medical history: Make a list of your key medical information, including other health conditions, medications, vitamins, or supplements you're currently taking, and any allergies you have.
6. Make a list of your medications: Create a comprehensive list of all medications, vitamins, herbal preparations, and supplements you're taking, including doses and frequency.
7. Consider bringing a family member or friend: Someone who accompanies you to the appointment may help remember important details discussed during the visit.
8. Prepare a list of questions: Compile a list of questions to ask your healthcare provider during the appointment. Some basic questions might include the cause of your condition, the recommended treatment options, and if there are any restrictions you should follow.
9. Expect your doctor to ask questions: Your healthcare provider may ask questions about your symptoms, medical history, and any recent activities that may have contributed to your condition. Remember to be honest and open with your healthcare provider about your symptoms and any concerns you may have. This information will help them provide the best possible care and guidance for your de Quervain tenosynovitis.