De Quervain’s Tenosynovitis

De Quervain’s tenosynovitis (or tendonitis) is named after the physician who first described this condition of inflammation of the tendons on the thumb side of the wrist in an anatomic location known as the first dorsal extensor compartment. This compartment contains several tendons that pull out and straighten the thumb. De Quervain’s tendonitis is an inflammation of these tendons. Tendons (cord-like fibers that attach muscle to bone) and synovium (a slick membrane that allows the tendons to glide easily) become irritated, causing pain. While the exact cause of de Quervain’s tendonitis is unknown, certain types of activities and employment may be a substantial contributing factor to the development of this condition.
Making the same motions over and over can irritate the tendons. So can an injury to the thumb side of the wrist. When the tendons are inflamed, they cause the lining of the tendon sheath to swell and thicken, or the tendon sheath itself may thicken. Then the sheath pinches the tendons. They can no longer slide easily inside the compartment or sheath, whereby straightening your thumb and wrist may then become painful.

The most common symptom is pain on the thumb side of the wrist. You may feel pain when you pinch or grasp things, turn or twist your wrist, or make a fist. The thumb may also “catch” when you bend it. The thumb side of the wrist may be tender to the touch, and you may feel a small knot. The diagnosis is made by history and physical exam. Bending your wrist toward the little finger side may be particularly painful and help lead to the diagnosis of de Quervain’s tendonitis. Treatment involves splinting, rest, anti-inflammatory medications, occupational therapy, cortisone injections, and alterations in activities and employment. Sometimes a permanent change in employment is necessary.

Cortisone injections are almost always helpful, at least temporarily. For ongoing pain, surgery is the definitive treatment. This can be performed under local anesthesia, with intravenous sedation, in an operating room, as an outpatient. A splint is worn for two weeks, followed by a removable splint. As with other hand surgery procedures, occupational therapy following surgery is nearly always mandatory. This is why we offer the services of a certified occupational hand therapist right in our office, as well as at several other locations. Complications include injury to the nerves that pass directly over the tendons in this area, scarring, and infection. Usually, the surgery is universally successful.