Understanding De Quervain's Tenosynovitis: Causes, Symptoms, Prevention, and Effective Treatments
▫️Written by John Keller
✅ Reviewed by Dr. Jenny Hynes on July 23, 2024
De Quervain's Tenosynovitis is a condition characterized by pain and swelling on the thumb side of the wrist. This inflammation affects the tendons of the thumb, making it difficult to grip or pinch objects. It is often caused by repetitive hand or wrist movements, which can lead to significant discomfort and limited hand function. The impact on daily activities can be profound, as even simple tasks such as opening jars, turning doorknobs, or lifting objects can become challenging.
Early diagnosis and treatment of De Quervain's Tenosynovitis are crucial to prevent the condition from worsening and to restore normal function. Effective management typically involves a combination of rest, splinting, anti-inflammatory medications, and physiotherapy. Timely intervention can significantly reduce pain and improve hand mobility, thereby enhancing the quality of life for affected individuals (Rosenbaum & Attanasio, 2018; Ilyas, 2009).
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What is de Quervain's tenosynovitis?
De Quervain's Tenosynovitis is a painful condition that affects the tendons on the thumb side of the wrist. It involves inflammation of the sheath, or synovium, that surrounds the two tendons responsible for thumb movement: the extensor pollicis brevis (EPB) and the abductor pollicis longus (APL).
Anatomy involved
The extensor pollicis brevis (EPB) and the abductor pollicis longus (APL) are two tendons that play a crucial role in thumb movement. The EPB tendon helps extend the thumb, allowing it to straighten and move away from the palm. The APL tendon, on the other hand, aids in abducting the thumb, enabling it to move away from the hand’s plane and rotate at the carpometacarpal joint.
These tendons run side by side in a narrow tunnel made of connective tissue along the wrist. When this tunnel becomes inflamed or irritated, it constricts the movement of the tendons, leading to pain, swelling, and difficulty moving the thumb and wrist. The inflammation of the synovium surrounding these tendons is what characterizes De Quervain's Tenosynovitis.
Causes of de Quervain's tenosynovitis
De Quervain's Tenosynovitis is primarily caused by repetitive hand or wrist movements and overuse. This repetitive stress can lead to irritation and inflammation of the tendons and their surrounding sheath. Common causes and contributing factors include:
Repetitive hand or wrist movements. Engaging in activities that require repetitive motion of the thumb and wrist, such as texting, playing musical instruments, or using tools, can strain the tendons and lead to inflammation.
Overuse. Overuse of the wrist and thumb, particularly in activities that involve grasping, pinching, or wringing motions, can contribute to the development of this condition. Athletes and individuals who frequently lift heavy objects are particularly at risk.
Injury. Direct injury to the wrist or tendons, such as a blow or strain, can result in inflammation and swelling, potentially leading to De Quervain's Tenosynovitis.
Inflammatory conditions. Inflammatory conditions, such as rheumatoid arthritis, can increase the likelihood of developing De Quervain's Tenosynovitis. These conditions cause widespread inflammation that can affect various tendons and joints, including those in the wrist.
Risk Factors. Certain factors can increase the risk of developing De Quervain's Tenosynovitis:
Pregnancy. Hormonal changes during pregnancy can lead to fluid retention and increased pressure within the tendon sheath, making pregnant women more susceptible to this condition.
Rheumatoid arthritis. Individuals with rheumatoid arthritis are at a higher risk due to the inflammatory nature of the disease, which can affect the tendons and their sheaths.
Occupations and hobbies. Jobs and hobbies that involve repetitive wrist and thumb movements, such as gardening, carpentry, knitting, or playing certain sports, can increase the risk of developing De Quervain's Tenosynovitis. These activities place constant stress on the tendons, leading to wear and inflammation over time.
Signs and symptoms of de Quervain's tenosynovitis
De Quervain's Tenosynovitis presents with a range of symptoms that can significantly affect hand function. The typical signs and symptoms include:
Pain. Pain is the most common symptom, usually felt on the thumb side of the wrist. It can be sharp and may radiate up the forearm. The pain often worsens with thumb and wrist movement, especially when gripping or lifting objects.
Swelling. Swelling near the base of the thumb is common and can be accompanied by a fluid-filled cyst in some cases. The swelling may make it difficult to move the thumb and wrist smoothly.
Difficulty moving the thumb and wrist. Affected individuals often experience a reduced range of motion and stiffness in the thumb and wrist. Activities that require pinching, gripping, or any movement involving the thumb can become challenging and painful.
Worsening with certain activities. Symptoms tend to worsen with activities that strain the tendons, such as gripping, lifting, pinching, or twisting motions. Everyday tasks like opening jars, turning doorknobs, or using scissors can exacerbate the pain and discomfort.
Prevention of de Quervain's tenosynovitis
Preventing De Quervain's Tenosynovitis involves adopting strategies to minimize strain on the thumb and wrist. Key preventive measures include:
Ergonomic tools. Using ergonomic tools designed to reduce strain on the wrist and thumb can help prevent the condition. Ergonomic handles on tools and office equipment can minimize awkward wrist positions and repetitive motions.
Proper techniques. Employing proper techniques when performing repetitive tasks is crucial. This includes maintaining a neutral wrist position, using the whole hand rather than just the thumb, and avoiding excessive force.
Regular breaks and rest periods. Taking regular breaks to rest the hands and wrists is essential, especially during activities that involve repetitive motions. Stretching and gentle exercises during these breaks can also help maintain tendon flexibility and strength.
Diagnosis of de Quervain's tenosynovitis
Diagnosing De Quervain's Tenosynovitis typically involves a combination of physical examination and specific tests:
Physical examination
A healthcare provider will conduct a thorough physical examination of the affected wrist and thumb. They will look for signs of swelling, tenderness, and pain.
Imaging tests
In some cases, imaging tests like ultrasound or X-rays may be used to rule out other conditions or to assess the extent of the inflammation. Ultrasound can visualize the tendons and their sheaths, while X-rays can help exclude bone-related issues.
Treatment options for de Quervain's tenosynovitis
Non-surgical treatments
Rest and immobilization. Resting the affected wrist and thumb is essential to reduce inflammation and allow the tendons to heal. Using splints or braces can immobilize the thumb and wrist, minimizing movement and strain on the tendons.
Application of ice and anti-Inflammatory medications. Applying ice to the affected area can help reduce swelling and alleviate pain. Over-the-counter anti-inflammatory medications, such as ibuprofen, can also be effective in managing symptoms.
Steroid injections. Steroid injections can be used to reduce inflammation and provide relief from pain. These injections deliver corticosteroids directly into the tendon sheath, reducing swelling and discomfort.
Surgical options
When surgery is necessary. Surgery may be considered if non-surgical treatments fail to provide relief or if the condition is severe and significantly impacts daily activities. Surgery aims to release the tendon sheath and reduce pressure on the tendons.
Overview of the surgical procedure. The surgical procedure, typically performed on an outpatient basis, involves making a small incision over the inflamed tendons. The surgeon then cuts the sheath to release the tendons, allowing them to move more freely. The incision is closed with sutures, and a splint is applied to protect the area during the initial healing period.
Recovery process. Recovery from surgery generally involves a period of immobilization followed by gradual rehabilitation. Patients may need to wear a splint or brace for several weeks to support the thumb and wrist. Physiotherapy is often recommended to restore strength, flexibility, and function.
Physiotherapy for de Quervain's tenosynovitis
Role of physiotherapy
Physiotherapy plays a crucial role in the treatment of De Quervain's Tenosynovitis. It helps in reducing pain, improving function, and preventing recurrence by addressing the underlying causes and promoting proper healing.
Specific physiotherapy techniques and exercises
Physiotherapists may employ various techniques and exercises to aid rehabilitation:
Manual therapy: Techniques such as massage and mobilization to reduce pain and improve tendon movement.
Stretching exercises: Gentle stretching exercises to improve flexibility and reduce stiffness.
Strengthening exercises: Targeted exercises to strengthen the muscles of the wrist and thumb, enhancing stability and function.
Activity modification: Guidance on modifying activities to reduce strain on the wrist and thumb.
Benefits of physiotherapy
Physiotherapy offers numerous benefits, including:
Pain reduction: Through manual therapy, exercises, and other modalities.
Improved function: Restoring strength and flexibility, enabling better performance of daily activities.
Prevention of recurrence: Educating patients on proper techniques and exercises to prevent future episodes.
Conclusion
Understanding De Quervain's Tenosynovitis is vital for early diagnosis and effective treatment. Recognizing the signs and symptoms, along with the risk factors, can help in taking preventive measures. Non-surgical treatments, such as rest, immobilization, and physiotherapy, can effectively manage the condition in many cases. However, surgery may be necessary for severe or persistent cases.
Seeking professional medical advice is crucial for proper diagnosis and treatment. Physiotherapy is particularly beneficial in managing De Quervain's Tenosynovitis, as it reduces pain, improves function, and helps prevent recurrence. Maintaining wrist health through proper techniques, ergonomic tools, and regular breaks can further protect against this condition.
References:
Goel, R., & Abzug, J. M. (2014). De Quervain’s Tenosynovitis: A Review of the Rehabilitative Options. HAND, 10(1), 1–5. https://doi.org/10.1007/s11552-014-9649-3
Ippolito, J. A., Hauser, S., Patel, J., Vosbikian, M., & Ahmed, I. (2018). Nonsurgical Treatment of De Quervain Tenosynovitis: A Prospective Randomized Trial. HAND, 15(2), 215–219. https://doi.org/10.1177/1558944718791187
Rabin, A., Israeli, T., & Kozol, Z. (2015). Physiotherapy Management of People Diagnosed with de Quervain’s Disease: A Case Series. Physiotherapy Canada, 67(3), 263–267. https://doi.org/10.3138/ptc.2014-47
Related links:
Understanding Wrist Injuries: Causes, Symptoms, Prevention, and Effective Treatments
Understanding Ganglion: Causes, Symptoms, Prevention, and Effective Treatments
Understanding Scaphoid Fracture: Causes, Symptoms, Prevention, and Effective Treatments
Understanding Wrist Fracture: Causes, Symptoms, Prevention, and Effective Treatments
Understanding Wrist Sprain: Causes, Symptoms, Prevention, and Effective Treatments
Article by
John Keller
Clinical Director | Sports & Musculoskeletal Physiotherapist
John graduated as a Physiotherapist from the Auckland University of Technology with the John Morris memorial prize for outstanding clinical practise in 2003. John has since completed Post Graduate Diplomas in both Sports Medicine and Musculoskeletal Physiotherapy with distinction, also collecting the Searle Shield for excellence in Musculoskeletal Physiotherapy.
Reviewed by
Dr. Jenny Hynes FACP
Clinical Director | Specialist Musculoskeletal Physiotherapist
Jenny sat extensive examinations to be inducted as a fellow into the Australian College of Physiotherapy in 2009 and gain the title of Specialist Musculoskeletal Physiotherapist, one of only a few physiotherapists in the state to have done so.