De Quervain's tenosynovitis
What is it?
This is a painful condition affecting the tendons in your wrist, specifically two at the base of the thumb, which are responsible for moving the thumb out and away from the palm of the hand. If you have de Quervain’s tenosynovitis, it will probably hurt when you turn your wrist, grasp anything or make a fist.
Why does it occur?
The exact cause is unknown, but can be due to activities that place significant amounts of 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 fascia holding tendons in place), and not an inflammation.
There is a preponderance in women, and anyone aged between 30 and 50, and is most commonly develops in the dominant wrist. De Quervain’s tenosynovitis is also associated with certain risk factors involving overuse activities, such as racquet sports and golf. The condition may also develop secondary to trauma.
What are the 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 it 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.
How is it treated?
Treatment will depend on the severity of the condition, and which option will give you the best long-term outcome. Your consultant will discuss with you all the various options.
The majority of cases can be resolved with rest, ice and anti-inflammatory medication. A thumb spica splint, to immobilize the thumb and/or wrist while allowing the other digits freedom to move, is often used but steroid injections may be considered as an alternative option.
This may be considered in the small number of patients with severe symptoms who haven’t responded to more conservative treatments over a period of 6 months. Surgery 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.
The One Orthopaedics team specialists
Consultant Hand Surgeon, FRCS
Consultant Orthopaedic Specialist FRCS (Tr & Orth)