De Quervain Tendiniti

De Quervain’s tenosynovitis is a painful condition that occurs when the two tendons responsible for thumb movement pass through a narrow tunnel in the wrist and become irritated. It is essentially a form of tendon entrapment and inflammation. The most common symptoms are sharp pain on the thumb side of the wrist, swelling, and difficulty with gripping activities.

This condition can develop due to repetitive wrist strain, occupational or sports-related activities, hormonal changes during pregnancy and postpartum, or improper wrist positioning while nursing. In treatment, the first step usually includes rest, ice application, and anti-inflammatory medications. Ultrasound-guided corticosteroid injections into the tendon sheath provide excellent relief in most patients. For cases where symptoms persist and injections fail to provide long-term benefit, surgical release of the tendons is considered.

What Is De Quervain’s Tenosynovitis?

De Quervain’s tenosynovitis is caused by the entrapment of two tendons — the abductor pollicis longus (APL) and the extensor pollicis brevis (EPB) — within the first dorsal compartment of the wrist. Normally, these tendons glide smoothly within their sheath. However, when the sheath narrows or the tendons thicken, friction increases, leading to inflammation (tenosynovitis), swelling, and pain.

The hallmark symptom is pain at the base of the thumb, especially during gripping, wrist rotation, or repetitive hand movements. In advanced cases, swelling, pain radiating into the thumb or forearm, and even catching or snapping sensations may occur. Everyday tasks such as holding a pen, opening a jar, or using a phone can become difficult.

What Causes De Quervain’s Tenosynovitis?

The main cause of De Quervain’s disease is repetitive strain of the thumb tendons within the tight tendon sheath of the wrist. This repetitive overload leads to inflammation, swelling, and narrowing of the tendon tunnel.

The most common risk factors include:

• Repetitive hand movements: Prolonged keyboard use, smartphones, gaming consoles, household chores, or occupational hand strain.
• New mothers: Holding or nursing the baby with improper wrist positioning often triggers symptoms.
• Hormonal changes: Pregnancy and postpartum hormonal shifts can cause tendon sheath narrowing, predisposing to inflammation.
• Wrist fractures: Wrist fractures increase mechanical stress on the tendons, leading to tenosynovitis.
• Sports and hobbies: Activities such as tennis, golf, and racket sports place repetitive stress on the thumb tendons.

Symptoms of De Quervain’s Tenosynovitis

The primary symptom is pain on the thumb side of the wrist. This pain may develop gradually or start suddenly and can radiate to the thumb or forearm.

Other common symptoms include:

• Pain during gripping and twisting: Activities like opening jars, writing, using a phone, or carrying a baby worsen the pain.
• Swelling: Localized swelling at the base of the thumb, sometimes accompanied by a fluid-filled cyst (ganglion cyst).
• Catching or snapping sensation: A feeling of tendon “sticking” within the sheath.
• Difficulty making a fist: Pain and swelling limit hand closure.
• Numbness: Occasional numbness in the thumb and index finger due to irritation of the superficial radial nerve.

If left untreated, these symptoms can progressively worsen and severely affect daily activities.

How Is De Quervain’s Disease Diagnosed?

Diagnosis is primarily clinical, based on history and physical examination. The most widely used test is the Finkelstein test:

• The patient places the thumb inside the palm.
• The other four fingers are wrapped over the thumb to form a fist.
• The wrist is bent toward the little finger (ulnar deviation).
• Sharp pain along the base of the thumb indicates De Quervain’s tenosynovitis.

In most cases, physical examination is sufficient. Imaging such as ultrasound or MRI is rarely needed unless another diagnosis is suspected.

How Is De Quervain’s Tenosynovitis Treated?

The primary goal of treatment is to reduce tendon sheath inflammation and control pain.

1. Non-Surgical Treatment Options

• Rest and activity modification: Avoiding repetitive wrist strain.
• Thumb spica splinting: A splint that immobilizes the thumb and wrist may provide symptom relief in the early stages. However, splints alone do not cure the disease and are usually combined with medications or injections.
• Ice therapy: Especially effective in the early stages to reduce swelling and inflammation.

How to Perform Ice Massage

• Fill a small plastic cup with water and freeze it.
• Peel away the top of the cup to expose the ice.
• Massage the exposed ice directly on the painful area of the wrist in circular motions.
• Continue for 5–7 minutes maximum to avoid skin irritation.
• Dry the area and allow it to rest.

Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) may be used under medical supervision.

2. Corticosteroid Injection

Among non-surgical options, ultrasound-guided corticosteroid injections are the most effective. Using ultrasound ensures the injection is placed into the tendon sheath, not the tendon itself, making the procedure safe with minimal risk.

Most patients experience rapid relief of pain and swelling, often regaining normal hand function quickly. Success rates are high, although the duration of benefit varies between individuals. Some patients achieve long-term relief, while others may have recurrent symptoms.

When Is Surgery Needed for De Quervain’s Tenosynovitis?

Non-surgical treatment is always the first choice in De Quervain’s disease. However, if:

• Rest, splinting, medications, and ice therapy, or
• Ultrasound-guided corticosteroid injections

do not provide sufficient relief, or if pain continues to significantly limit daily activities, surgical treatment becomes necessary. Surgery offers a permanent solution for patients who do not respond to conservative options.

How Is De Quervain’s Surgery Performed?

The procedure is usually performed under local or general anesthesia. A tourniquet is applied to the arm to provide a bloodless surgical field.

• The tight compartment through which the thumb tendons pass is carefully opened.
• This allows the tendons to move freely and relieves the entrapment.
• The small sensory branch of the radial nerve that runs close to the surgical field is meticulously protected.

The operation is typically short, and most patients can go home the same day. A light bandage or splint may be used for a short period during recovery. For the majority of patients, surgery provides lasting pain relief and restoration of hand function.

Recovery After De Quervain’s Surgery

Recovery is usually fast following surgical release for De Quervain’s tenosynovitis. Most patients are discharged the same day.

• First days: The wrist is protected with a light bandage or splint. Elevating the hand reduces swelling.
• 1–2 weeks: Bandage is removed. Dissolvable sutures are commonly used, so stitches usually do not need to be taken out. Light daily activities can be resumed with minimal pain.
• 2–4 weeks: Thumb and wrist motion improve gradually, and grip strength increases.
• 4–6 weeks: Most patients return to work and normal activities, with pain largely resolved.

Physical therapy is not routinely required. In patients with prolonged symptoms, simple wrist exercises may help speed up recovery.

Frequently Asked Questions About De Quervain’s Tenosynovitis