Among conditions featuring inflammation and pain, de Quervain’s tenosynovitis sticks out like a sore thumb. Even though de Quervain’s tenosynovitis sounds unusual, it’s common enough. Approximately 0.5 percent of men and 1.3 percent of women have de Quervain’s.1 The condition got its name in 1895, from the Swiss surgeon Fritz de Quervain who first identified it.2

The main indications of de Quervain’s tenosynovitis include the following2:

  • Swelling and pain at the base of the thumb, particularly when moving the thumb or wrist or making a fist
  • Tenderness on the thumb side of the wrist
  • Weakened grip
  • Feeling or hearing creaking in the area

Grip gripes

The six extensor tendon compartments on the back side of the wrist are known as dorsal compartments.3 The first and third of these compartments hold tendons that control the thumb.3 However, “de Quervain’s stenosing tenovaginitis refers to the first dorsal wrist compartment only,” notes Geoffrey Durham-Smith, MD, FRCS, FRACS, plastic and hand surgeon at Baptist Health Louisville in Kentucky.

A thin, slippery, soft-tissue layer called the synovium covers tendons to allow them to slide easily through the fibrous tunnel, also known as a sheath.4 De Quervain’s occurs when the tendons themselves swell4 or the synovium surrounding the two tendons running between the wrist and thumb thickens2—usually after overuse or repetitive movements that pull the thumb away from the wrist.2 These tendons are the extensor pollicis brevis and the abductor pollicis longus,5 and they share a fibrous sheath.6 The tunnels thereby become narrower, resulting in friction (as the tendons try to move within them).4 Pain may travel up the forearm and may appear gradually or suddenly.4

Repetitive movements that may cause de Quervain’s include the following2:

  • Playing tennis
  • Golfing
  • Typing
  • Playing piano
  • Performing carpentry

Other possible causes include the following1,2:

  • Carrying a child (in which case the pain can be bilateral)
  • Changes in hormones (such as in expectant mothers)
  • Scar tissue left by an injury
  • Inflammatory arthritis

New mothers can expect relief four to six weeks after delivering.3

“De Quervain’s is seen in many patients complaining of hand pain and seems to affect middle-aged and elderly patients with much greater frequency than young adults,” notes Melanie Robinson, CMA (AAMA), CCP, who works as the billing manager in the office of Martin Fox, MD, and Associates, in Louisville, Kentucky. While the office consists of four board-certified plastic and reconstructive surgeons, Robinson notes that plastic surgeons are first trained in hand surgery and then choose to receive additional training in plastic surgery.

Wrist watch

“Clinical history (site and timing of the pain) along with clinical examination (swelling, pain, and tenderness), of which the Finkelstein’s test is one part, leads to the diagnosis,” says Dr. Durham-Smith.

The Finkelstein’s test consists of placing the thumb in the palm and making a fist and then bending the fist toward the little finger.2 Accompanying pain indicates de Quervain’s.2

The first step in treating de Quervain’s is for patients to stop doing whatever it was that caused the condition in the first place2; the pain may disappear with no treatment.1 Additionally, physicians may tell patients to do any of the following to help with the pain:

  • Wear a splint for two to three weeks.2
  • Use heating pads and cold packs.2
  • Take over-the-counter pain relievers, such as acetaminophen (Tylenol), ibuprofen (Advil), or other anti-inflammatory medications.3
  • See a physiotherapist for physical therapy.2

“The most effective treatment for this condition, when symptoms warrant and are significant, is a shot of cortisone,” says Mark S. Cohen, MD, professor, director, section of hand and elbow, department of orthopedic surgery, Rush University Medical Center in Chicago. “This is a very strong anti-inflammatory medication that leads to resolution of the tendonitis in the vast majority of patients.”

Approximately 50 percent of patients find relief after only one injection, while a second injection aids an additional 40 to 45 percent.1 “If the problem returns a few months after an injection, I will often repeat it before moving on to surgical consideration,” notes Brian K. Hutchinson, MD, orthopedic surgeon, Kaiser Permanente West Los Angeles Medical Center.

If a patient is still experiencing pain after trying a couple of corticosteroid injections, the physician may request an ultrasound to determine the cause.2 An operation may be necessary to open the dorsal compartment and tendon sheath over the affected tendons to make more room for them.4

Some patients develop a fluid-filled cyst on the thumb side of the wrist.4 “The cyst occurs when fluid from the tendon sheath bulges out of the compartment due to inflammation,” says Dr. Cohen. “The cyst … requires no actual treatment. Resolution of the condition—the tenosynovitis—will lead to resolution of the cyst.”

“Frequently, these [cysts] respond to the same conservative treatments as the tenosynovitis—such as rest, ice, bracing, and anti-inflammatories, as well as cortisone injections,” says Dr. Hutchinson. “When large, these cysts may be aspirated. If the patient ultimately elects for surgical treatment, the ganglion would be excised during the release of the tendon sheath.”

Some patients’ anatomy can differ from the norm, warns Adil N. Esmail, MD, chief of service, department of orthopedics, Kaiser Permanente Panorama City Medical Center in California. “For example, the abductor pollicis longus and extensor pollicis brevis can be in separate compartments within the first compartment, and surgery fails when not realizing these extra compartments exist within the first compartment.”

Although patients may need to wear braces for certain activities and take care to avoid reinjuring the tendon, full recovery is generally the prognosis for de Quervain’s patients.5