De Quervain's Tenosynovitis
What is De Quervain's Tenosynovitis?
This is a painful condition affecting the tendons in your wrist. Specifically, the tendons at the base of the thumb are affected. These tendons are responsible for moving the thumb out and away from the palm of the hand.
Turning the wrist, grasping objects and making a fist can be painful if you have De Quervain’s tenosynovitis.
Why does De Quervain's Tenosynovitis occur?
The exact cause is unknown, but can be due to activities that place significant pressure on the tendons surrounding the wrist, such as writing for long periods of time or working in a position that requires the repetitive movement of your thumb and wrist. It is thought to be secondary to a thickening and swelling of the retinaculum (a band of tissue holding tendons in place), and not an inflammation.
It generally affects women more than men, those aged 30-50 years, and most commonly develops in the dominant wrist. Activities involving overuse of the tendons increase the risk of developing De Quervain’s tenosynovitis, including racquet sports and golf. The condition may also develop secondary to a trauma or injury. It is frequently seen in new parents as a result of holding and feeding their child.
De Quervain's Tenosynovitis symptoms?
Pain and swelling at the base of the thumb are the most common symptoms. The pain can be be aggravated by certain thumb movements which involve the affected tendons.
How is De Quervain's Tenosynovitis diagnosed?
Your consultant will usually be able to establish whether you are suffering from tenosynovitis after taking a medical history and examining the affected wrist. Further investigations are not normally needed, but in some cases x-rays may be required to rule out other causes.
De Quervain's Tenosynovitis treatment
Treatment will depend on the severity of the condition and the best long-term outcome. Your consultant will go through the available options with you.
Non-surgical treatment
The majority of cases can be resolved with rest, ice and anti-inflammatory medication. A thumb splint may be used to immobilise the thumb and/or wrist while allowing the fingers freedom to move. In some cases, steroid injections may be considered.
Surgical treatment
Surgery may be considered in a small number of patients with severe symptoms, who haven’t responded to more conservative treatments over a period of 6 months or more. The procedure involves the surgical release of the retinaculum or sheath surrounding the affected tendons at the base of the thumb. This reduces pressure and enables the tendons to glide freely, thereby reducing pain.
Treatment options
The One Orthopaedics team specialists
Anthony Hearnden
Consultant Orthopaedic Surgeon FRCS (Tr&Orth), Shoulder, Elbow, Hand and Wrist
