Anatomy of the Tendons of the Hand
The hand is one of the most complex and important parts of the body. Its movement depends on tendons, which are thick, flexible tissues that attach muscle to bone and allow motion of the fingers, thumb, and wrist. Each tendon is covered by a thin layer called the tendon sheath, which produces fluid to reduce friction during movement.
On the thumb side of the wrist, two tendons are especially important: the extensor pollicis brevis and the abductor pollicis longus. These tendons control thumb extension and lifting, helping you grasp and release objects. When these tendons become irritated, swollen, or compressed, a painful condition called De Quervain's tenosynovitis can develop.
What is De Quervain's Tenosynovitis?
De Quervain's tenosynovitis is a painful condition involving irritation of the tendon sheath on the thumb side of the wrist. When the sheath becomes inflamed, it restricts the smooth gliding of the tendons, leading to pain, swelling, and difficulty moving the thumb.
This condition is also referred to as:
- De Quervain's tendonitis
- De Quervain's tendinosis
- De Quervain's disease
- De Quervain's syndrome
Regardless of the name, all describe the same problem—irritated tendons at the base of the thumb.
Causes of De Quervain's Tenosynovitis
The exact cause of this painful condition is not always clear, but several risk factors are known:
- Repetitive wrist movements such as lifting a baby, typing, gardening, or racket sports.
- Chronic overuse of the hand and wrist from work or hobbies.
- Recent injuries or direct trauma to the wrist that irritates the tendon sheath.
- Inflammatory arthritis, such as rheumatoid arthritis, that can cause tendon swelling.
- Pregnancy, likely due to hormonal changes and repetitive childcare tasks.
Middle-aged women are most commonly affected, though anyone can develop this painful tendon condition.
Signs and Symptoms of De Quervain's Tenosynovitis
The main symptom is pain along the thumb side of the wrist, especially at the base of the thumb. Patients often describe a painful condition that makes it hard to grip or pinch.
Other symptoms include:
- Swelling or thickening at the affected area.
- Thumb pain that worsens with motion or when making a fist.
- A “catching” or “snapping” sensation with thumb movement.
- Tenderness when pressing over the tendon sheath.
- Difficulty with normal use of the hand, such as opening jars or lifting objects.
How De Quervain's Tenosynovitis is Diagnosed
A doctor can usually diagnose De Quervain's tenosynovitis based on your history and a physical exam.
A simple test called the Finkelstein test is most commonly used. You are asked to make a fist with your thumb tucked inside the fingers, then bend your wrist toward the little finger. If this causes sharp wrist pain on the thumb side, the diagnosis is confirmed.
In most cases, imaging tests like X-rays are not necessary, but they may be ordered to rule out arthritis or recent injuries.
Non-Surgical Treatments for De Quervain's Tenosynovitis
Many patients improve with at home treatments and conservative care.
Non-surgical treatment options include:
- Activity modification: Avoiding repetitive hand and wrist movements that worsen symptoms.
- Thumb spica splint: A brace that supports the wrist and immobilizes the thumb, allowing irritated tendons to rest.
- Ice therapy: Applying ice to the affected area to reduce swelling.
- Anti-inflammatory medications: NSAIDs help relieve pain and decrease inflammation.
- Corticosteroid injection: A highly effective option to reduce swelling and relieve tendon pain.
- Physical therapy: A physical therapist or occupational therapist can teach stretching, strengthening, and ergonomic techniques.
With proper treatment, symptoms often improve within a few weeks.
Surgical Treatment for De Quervain's Tenosynovitis
If conservative care fails, surgery for De Quervain's may be recommended.
The surgical procedure, often called De Quervain's release, is performed by an experienced doctor or hand surgeon. The surgeon makes a small incision over the tendon sheath and carefully releases it, creating more room for the tendons to glide. This prevents ongoing irritation and allows normal movement of the thumb and wrist.
The surgery is typically an outpatient procedure, performed under local anesthesia. Recovery involves wearing a splint for a short period, followed by physical therapy to restore mobility and strength.
Recovery After Surgery for De Quervain's Tenosynovitis
After thumb surgery, patients usually wear a splint for several weeks. Fingers remain free, allowing gentle hand movement.
Postoperative care may include:
- Thumb spica splint for protection.
- Hand therapy exercises to reduce stiffness and scar tissue.
- Gradual return to normal use of the hand.
- Pain management with medications and home treatment strategies.
Most patients regain full function of the thumb and wrist within a few weeks, though recovery may vary depending on age, activity level, and whether inflammatory arthritis is present.
Everyday Life with De Quervain's Tenosynovitis
Living with this condition can be frustrating. Activities like lifting a child, turning doorknobs, or even squeezing a tennis ball may cause pain.
Fortunately, most people improve significantly with treatment for De Quervain's. Early care is important to prevent long-term tendon damage or limited motion.
How to Prevent De Quervain's Tenosynovitis
While not all cases can be prevented, you can reduce your risk:
- Take frequent breaks during repetitive physical activity.
- Use ergonomic tools and proper posture with wrist motions.
- Strengthen hand and wrist muscles with exercises prescribed by a physical therapist.
- Address underlying inflammatory conditions with your doctor.
When to See a Doctor
If you feel pain along the side of the wrist that doesn't improve with rest or home treatment, it is important to seek professional care. Early diagnosis and treatment help prevent worsening symptoms.
An orthopaedic surgeon or hand specialist can help you treat De Quervain's tenosynovitis effectively with the right combination of therapies.
Why Choose Dr. Neustein for Hand and Wrist Care
At Specialty Orthopaedics, Dr. Thomas Neustein specializes in hand and upper extremity surgery. With years of expertise in treating hand and wrist injuries, including De Quervain's tenosynovitis, Dr. Neustein provides comprehensive care—ranging from at home treatments and injections to advanced hand surgery when needed.
Patients trust Dr. Neustein and his team for personalized care, effective treatment options, and excellent outcomes.
Call to Action
If you are experiencing thumb pain, swelling, or difficulty with wrist movements, don't wait for symptoms to worsen. Schedule an appointment with Dr. Neustein today to treat De Quervain's tenosynovitis and get back to normal use of your hand.
