What are the symptoms of De Quervain Tenosynovitis?

Common symptoms include: Pain along the thumb side of the wrist, especially with movement; Pain that may radiate into the thumb or up the forearm; Swelling or thickening along the thumb side of the wrist; Pain worsened by gripping, pinching, or twisting motions; Difficulty with activities like opening jars or turning doorknobs.

How is De Quervain Tenosynovitis diagnosed?

Diagnosis typically involves: Medical history focusing on symptoms, activities, and occupation; Physical examination of the wrist and thumb; Finkelstein test: pain when making a fist over thumb and ulnar deviation; Palpation for tenderness and swelling over the first dorsal compartment.

What are the treatment options for De Quervain Tenosynovitis?

Treatment options range from conservative measures to surgical interventions, including: Rest and activity modification to avoid aggravating motions; Thumb spica splint to immobilize the wrist and thumb; Ice application to reduce swelling; NSAIDs for pain and inflammation; Corticosteroid injection into the tendon sheath (often effective).

De Quervain Tenosynovitis

Also known as: De Quervain's tenosynovitis, De Quervain's tendinitis, De Quervain's tendonitis, De Quervain disease, De Quervain syndrome, First dorsal compartment tenosynovitis, Radial styloid tenosynovitis

Last updated: December 18, 2024

De Quervain tenosynovitis is a painful condition of the tendons on the thumb side of the wrist. It occurs when the abductor pollicis longus and extensor pollicis brevis tendons become irritated or constricted as they pass through a fibrous tunnel at the wrist, causing pain with thumb and wrist movement. Symptoms can include swelling or thickening and pain that may radiate into the thumb or forearm. Many cases respond to conservative treatment such as rest and activity modification.

Key Facts

•De Quervain tenosynovitis is a painful condition affecting the tendons on the thumb side of the wrist
•Pain along the thumb side of the wrist, especially with movement
•Diagnosed through history, physical exam, and imaging
•First-line treatment includes exercise, weight management, and activity modification

What It Is

De Quervain tenosynovitis is a painful condition affecting the tendons on the thumb side of the wrist. It occurs when the tendons of the abductor pollicis longus and extensor pollicis brevis muscles become irritated or constricted as they pass through a fibrous tunnel at the wrist. This results in pain with thumb and wrist movement.

Affected Anatomy

This condition affects several structures in and around the joint:

•Abductor pollicis longus tendon
•Extensor pollicis brevis tendon
•First dorsal compartment of the wrist (the fibrous tunnel)
•Tendon sheath (synovium surrounding the tendons)
•Radial styloid area at the base of the thumb

Common Symptoms

Symptoms can vary in intensity and may change over time. Common experiences include:

•Pain along the thumb side of the wrist, especially with movement
•Pain that may radiate into the thumb or up the forearm
•Swelling or thickening along the thumb side of the wrist
•Pain worsened by gripping, pinching, or twisting motions
•Difficulty with activities like opening jars or turning doorknobs
•Snapping or catching sensation with thumb movement (less common)
•Tenderness over the radial styloid area
•Gradual onset of symptoms that may worsen without treatment

Causes and Risk Factors

Multiple factors can contribute to the development of this condition:

Causes

•Overuse or repetitive hand and wrist motions
•Repetitive lifting, especially with the wrist in an awkward position
•Activities requiring forceful gripping with ulnar deviation
•New or increased activity involving thumb use
•Inflammatory conditions affecting tendon sheaths

Risk Factors

•Female sex (significantly more common in women)
•Age between 30 and 50 years
•Pregnancy and postpartum period
•Caring for a new baby (lifting with thumb extended)
•Occupations or hobbies with repetitive hand use
•Rheumatoid arthritis or other inflammatory conditions
•Previous wrist injury

How It's Diagnosed

Diagnosis typically involves a combination of clinical assessment and imaging studies:

•Medical history focusing on symptoms, activities, and occupation
•Physical examination of the wrist and thumb
•Finkelstein test: pain when making a fist over thumb and ulnar deviation
•Palpation for tenderness and swelling over the first dorsal compartment
•Assessment of range of motion and pain with movement
•X-rays may be ordered to rule out other conditions but are often normal
•Ultrasound may visualize tendon and sheath changes

Treatment Options

Treatment approaches range from conservative measures to surgical interventions, often starting with the least invasive options:

Self-Care and Activity Modification

•Rest and activity modification to avoid aggravating motions
•Thumb spica splint to immobilize the wrist and thumb
•Ice application to reduce swelling

Physical Therapy and Exercise

•Physical or occupational therapy for stretching and strengthening

Medications

•NSAIDs for pain and inflammation

Injections and Office-Based Procedures

•Corticosteroid injection into the tendon sheath (often effective)

Surgery

•Surgical release of the first dorsal compartment if conservative treatment fails

Prognosis and Recovery

The course of this condition varies between individuals:

•Many cases respond to conservative treatment including splinting and injection
•Corticosteroid injections provide relief in a majority of patients
•Symptoms may recur if aggravating activities are resumed
•Surgical release is typically successful for cases not responding to conservative care
•Early treatment may prevent progression to more chronic symptoms

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