De Quervain’s tenosynovitis is a condition that causes pain or swelling of the tendons near the base of the thumb.
The tendons affected include the abductor pollicis longus and the extensor pollicis brevis. Individuals with this condition experience pain when turning their wrist, trying to hold something or making a fist.
Tendons attach muscles to the bones and slide through a tunnel of tissue called a sheath. The sheath helps keep the tendons in place. When the tendons become thick or swollen, they create friction with the sheath. This causes pain and difficulty moving the thumb and wrist in certain motions.
Symptoms and Causes of De Quervain’s Tenosynovitis
Signs of this condition may include:
- Pain or swelling near the base of the thumb
- Difficulty moving the thumb and wrist when trying to grasp or pinch something
- A “sticking” or “stop-and-go” sensation in the thumb when moving it
- Pain that worsens when using the hand and thumb
- Pain that appears suddenly or develops over time
- Sensing a snapping or popping in the wrist when moving the thumb
If left untreated, the pain may spread further into the thumb and or back into the forearm. Movements that involve pinching and grasping aggravate the pain.
Other causes may include direct injury to the wrist or tendon and inflammatory arthritis, such as rheumatoid arthritis.
Risk Factors of De Quervain’s Tenosynovitis
The following factors increase the likelihood of developing de Quervain’s tenosynovitis:
- Between the ages of 30 and 50
- Lifting a child
- Jobs or hobbies that require repetitive hand and wrist movements
Diagnosis of De Quervain’s Tenosynovitis
Patients experiencing one or more of the symptoms of de Quervain’s tenosynovitis should schedule an appointment with their physician. During the first visit, the physician will examine the patient’s hand to see if they feel pain when pressure is applied to the thumb.
The physician will perform a Finkelstein test, during which the patient will be asked to bend their thumb across the palm of their hand and bend their fingers down over the thumb. The patient will then bend their wrist toward their little finger. If the patient feels pain during this test, then they likely have de Quervain’s tenosynovitis.
The patient may have their thumb and wrist immobilized with a splint or brace to keep them straight and rest the tendons. The patient will be instructed to avoid making repetitive thumb movements and pinching with the thumb when moving the wrist from side to side. Physical therapy may be another option to help the patient strengthen their muscles, reduce pain and limit tendon irritation.
If these treatment options fail to provide lasting pain relief, the patient may benefit from an abductor pollicis and external pollicis brevis injection.
What to Expect During the Procedure
The procedure begins with the physician cleansing the injection site with an antiseptic. The physician will use ultrasonic guidance to ensure the needle is inserted in the correct place. Once the needle is correctly positioned, the local anesthetic and steroid will be injected.