What You Need to Know About De Quervain’s Tenosynovitis and How to Treat It

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What You Need to Know About De Quervain’s Tenosynovitis and How to Treat It

De Quervain’s tenosynovitis is a condition that causes pain and swelling along the thumb side of the wrist. It affects the tendons that control thumb movement and can make everyday tasks like gripping, pinching, and turning objects uncomfortable. This guide explains what you need to know about De Quervain’s tenosynovitis, including its causes, symptoms, and treatment options.

What Causes De Quervain’s Tenosynovitis?

De Quervain’s tenosynovitis is typically caused by repetitive movements that strain the tendons around the wrist. The condition occurs when the tendons of the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) muscles become inflamed due to repetitive friction or overuse. Activities like gripping, lifting, and pinching are common culprits, especially when combined with wrist movements like radial deviation (moving the wrist away from the body) or ulnar deviation (moving the wrist toward the body).

Some of the most common triggers include:

Gardening
Knitting
Cooking
Playing sports like golf, volleyball, or fly fishing
Texting or using mobile devices, which has become a significant cause of De Quervain’s tenosynovitis in recent years

Who’s At Risk?

Anyone can develop De Quervain’s tenosynovitis, but certain groups are more likely to experience it. It is particularly common among:

New mothers, often referred to as “mommy thumb” due to the repetitive motions of lifting babies.
Athletes in sports that require repetitive wrist motions, such as racquet sports or golf.
Workers who perform repetitive tasks, like carpentry, or video game players.

Women are affected more often than men, especially during pregnancy and the postpartum period, due to hormonal changes. Other risk factors include diabetes, rheumatoid arthritis, and even Vitamin D deficiency, which can weaken bone health and contribute to conditions like De Quervain’s tenosynovitis.

Recognizing the Symptoms

The most common symptoms of De Quervain’s tenosynovitis include:

Pain on the thumb side of the wrist, which may radiate up the forearm
Swelling around the base of the thumb
Pain that worsens with specific thumb or wrist movements, such as pinching, grasping, or twisting
A catching or snapping sensation when moving the wrist
Numbness or tingling in the thumb or index finger (if the sensory branch of the radial nerve is irritated)

How Is It Diagnosed?

Diagnosis is often based on a physical exam and a few specific tests:

Finkelstein’s Test: One of the most reliable diagnostic tests for De Quervain’s. It involves bending the thumb down and ulnar deviating the wrist (moving it toward the pinky). If it causes sharp pain, the test is positive.
WHAT Test: This involves moving the wrist into hyperflexion while abducting the thumb. Pain during this movement is a strong indicator of De Quervain’s disease.

An ultrasound or MRI may also be used, especially if symptoms are severe or do not improve with initial treatment.

Treatment Options for De Quervain’s Tenosynovitis

Treatment for De Quervain’s tenosynovitis focuses on reducing inflammation and managing pain. Here are some options:

1. Rest and Activity Modification

The first step in treatment is to avoid activities that provoke pain. If you enjoy activities like golf, gardening, or video gaming, consider taking regular breaks to rest your wrist and thumb. Texting and typing can also strain the wrist, so reducing these activities is helpful.

2. Cold Therapy

Applying ice or using cryotherapy can help reduce swelling and numb the pain. You can apply an ice pack for 15-20 minutes several times a day, especially after activities that strain the wrist.

3. Bracing and Splints

A thumb spica splint can be helpful for immobilizing the wrist and thumb, reducing the strain on the tendons. This method allows the tendons to heal without being aggravated by repetitive movements. However, long-term use may not be ideal, as some studies suggest that immobilization without other treatments may slow progress.

4. Physical Therapy and Stretching Exercises

Once the acute pain subsides, it’s important to focus on strengthening and improving mobility. Stretching exercises for the APL, EPB, and wrist muscles can help restore normal movement. Gradually incorporate strengthening exercises using resistance bands or light weights. Movement screens can also be useful to ensure that the wrist is functioning properly.

5. Corticosteroid Injections

For patients who don’t respond to conservative treatments, a cortisone injection can provide quick relief. This treatment has been shown to be effective in about 80% of cases. It helps reduce inflammation and can bring relief in the short term, although multiple injections may be necessary.

6. Surgery

Surgery is rarely needed but may be an option for patients who do not respond to conservative treatments and injections. It involves releasing the tendon sheath to relieve pressure and restore normal movement.

Self-Care and Prevention

Prehabilitation: Doing wrist-strengthening exercises before the onset of symptoms can help you stay injury-free.
Proper technique: Use proper lifting techniques when handling children or heavy objects to avoid straining your wrist.
Ergonomics: Adjust your workstation and the way you hold devices to reduce strain on your wrist.
Massage and Myofascial release: Techniques such as massage and dry needling can relieve tension in the wrist and surrounding muscles, improving mobility and reducing pain.

If your symptoms persist despite home treatment or worsen over time, consult a healthcare professional. Early intervention can help prevent the condition from becoming chronic.

De Quervain’s tenosynovitis is a treatable condition, and with the right approach, you can get back to your normal activities. By focusing on rest, physical therapy, and sometimes injections, you can manage the pain and improve wrist function. If conservative treatments don’t work, surgery is a last resort but often brings good results.

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