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De Quervain's Tenosynovitis

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(De Quervain’s Syndrome; De Quervain’s Disease; Washerwoman’s Sprain)

Definition

De Quervain's tenosynovitis is an inflammation of the sheaths of the tendons (tenosynovium) that move the thumb away from the hand. It is technically referred to as a stenosing tenosynovitis. Both the tendons and their surrounding tissue sheaths are involved in the area where the tendon has to go through a small tunnel of bony and fibrous tissue at the wrist. The inflamed tenosynovium becomes painful at the tunnel area.
Treatment includes rest and medications. In rare cases, surgery may be necessary.
De Quervain's Tenosynovitis
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Causes

De Quervain’s is a mechanical problem caused by repetitive use of the thumb and wrists. A direct blow to the area may also cause the condition.

Risk Factors

De Quervian's tenosynovitis is more common in women. Other factors that may increase your chance of getting de Quervian's tenosynovitis include:
  • Knitting and needlepoint
  • Lifting a baby or young child often
  • Bowling

Symptoms

Symptoms may include:
  • Pain or tenderness at the base of the thumb
  • Pain when pinching
  • Swelling over the thumb side of the wrist
  • A snapping or catching sensating when moving the thumb
  • Numbness on the back of the thumb radiating to the index finger

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done.
The Finkelstein test is often done to help make the diagnosis. Make a fist with your thumb inside your fingers and bend your wrist toward your little finger. If this causes pain at the wrist below your thumb, you may have de Quervain's tenosynovitis.

Treatment

Talk with your doctor about the best treatment plan for you. Treatment options include the following:

Conservative Measures

Nonsurgical methods to help relieve pain include:
  • Resting the thumb and wrist.
  • Use an ice pack for 15-20 minutes at a time. Place a towel between the ice pack and your skin.
  • Avoid activity that causes the pain.
  • Using a thumb splint to reduce pain and swelling. This allows the wrist to rest.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as acetaminophen or ibuprofen.

Cortisone Injection

An injection of a cortisone-like drug into the tendon sheath is often effective in curing the condition.

Surgery

When all else fails, an orthopedic surgeon will open up the small tunnel of bony and fibrous tissue and possibly remove some of the tendon sheath. This will allow more freedom of movement for the tendons.

Prevention

To help reduce your chances of getting de Quervain's, minimize repetitive twisting and gripping activities.

RESOURCES

American Academy of Orthopedic Surgeons http://orthoinfo.org

American College of Sports Medicine http://acsm.org

CANADIAN RESOURCES

Canadian Orthopaedic Association http://www.coa-aco.org

Physical Therapy Canada http://www.physicaltherapy.ca

References

Best treatment for de Quervain's tenosynovitis uncertain. Am Fam Physician. 2003;68(3):536.

Corticosteroid injection for treatment of de Quervain's tenosynovitis: a pooled quantitative literature evaluation. J Am Board Fam Pract. 2003;16(2):102-6.

de Quervain syndrome. Merck Manual for Health Care Professionals website. Available at: http://www.merckmanuals.com/professional/musculoskeletal%5Fand%5Fconnective%5Ftissue%5Fdisorders/hand%5Fdisorders/de%5Fquervain%5Fsyndrome.html. Updated March 2013. Accessed May 6, 2013.

de Quervian tendinitis (de Quervian tendinosis). American Academy of Orthopaedic Surgeons Ortho Info website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00007. Updated October 2007. Accessed May 6, 2013.

de Quervain tenosynovitis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated July 13, 2011. Accessed May 6, 2013.

Johnson CA. Occurrence of de Quervain's disease in postpartum women—pain and tenderness in wrist. J Fam Pract. 1991 Mar;32(3):325-7.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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