De Quervain’s tenosynovitis is a relatively common tendon condition that affects the thumb side of the wrist. The condition affects two of the main tendons to the thumb, the abductor pollcis longus and extensor pollcis brevis, which run through a sheath that crosses over the thumb side of the wrist into the hand. Healthy tendons are lined with a protective, slippery soft tissue layer called synovium that allows the tendons to slide easily through the sheath. When the tendons become inflamed or swollen, or the tendon sheath thickens, it can cause increased friction and pain during certain movements of the hand.

Symptoms

Patients presenting with de Quervain’s tenosynovitis often feel pain when they turn their wrist, make a fist, or grasp objects. Common symptoms include:

• Pain and Swelling: A chief complaint of patients with de Quervain’s tenosynovitis is a dull or sharp pain at the base of the thumb that worsens with motion in the thumb and wrist. The base of the thumb is usually swollen and tender to the touch.
• Impaired Grasping and Movement: Patients may have trouble gripping objects, as the grasping action causes pain and discomfort in the thumb. Due to pain and inflammation, patients may have limited movement in the thumb and wrist.
• Snapping Sensation: Patients may feel a catching sensation when they move their thumb.

If left untreated, de Quervain’s tenosynovitis can lead to worsening of symptoms and may eventually result in loss of function in the affected thumb and wrist. It’s important to see a qualified hand surgeon to get a proper diagnosis and review your treatment options. Our board-certified hand surgeons see patients at our Northern Arizona Hand Center in Flagstaff, AZ.

Risk Factors

The condition may be caused by overuse of the thumb and wrist. Pregnant and breastfeeding women, as well as those with rheumatoid arthritis are more likely to develop de Quervain’s tenosynovitis. Overall, the condition is more common in women and people in their 40s and 50s.

Diagnosis

During your consultation, your hand surgeon will touch your thumb and wrist to evaluate incidence of pain and swelling. They will also ask you to put your thumb in your palm, wrap your other fingers around it making a fist, and then bend your wrist downward toward your little finger. This is called the Finkelstein/Eichhoff test. If you feel pain at the base of the thumb on the wrist, it’s a positive sign that you have de Quervain’s tenosynovitis.

Non-Surgical Treatments for De Quervain’s Tenosynovitis

When treating de Quervain’s tenosynovitis, we first aim to exhaust non-surgical treatments to reduce swelling and irritation in the affected tendons and tendon sheath. We usually recommend splinting, rest, and non-steroidal anti-inflammatory drugs as a first line of defense to knock down inflammation. If that doesn’t relieve symptoms, then we’ll try corticosteroid injections into the tendon sheath. Steroid injections are usually very effective, and up to 80% of patients have relief after one or two injections.

De Quervain’s Tenosynovitis Release Surgery

If non-surgical treatments don’t work, then your hand surgeon may recommend surgery to release the tendon sheath, making more room for the tendons to move. During the procedure, your surgeon will cut the sheath enclosing your tendons, called the extensor retinaculum, and will also remove excess tissue, or tenosynovium. We perform de Quervain’s tenosynovitis release surgery on an outpatient basis at our ambulatory Northern Arizona SurgiCenter in Flagstaff, AZ. The procedure is completed under a local anesthetic or nerve block. Surgical complications are very rare, and patients can usually resume normal hand use as soon as they feel comfortable doing so.

Medical Review: This procedural information has been medically reviewed by plastic and reconstructive surgeon, Brian A. Cripe, M.D.