DeQuervain’s Tenosynovitis is a painful irritation of the tendons on the thumb side of the wrist. The tendons affected include the extensor pollicus brevis and the abductor pollicus longus tendons. They run along the back of the thumb and over the wrist and enable movement of the thumb away from the rest of the hand.
Causes of Injury
Inflammation of the tendons and the sheath that covers them can occur due to overuse, injury or disease process. This causes swelling or thickening of the tendons. Once this occurs, it is difficult for the tendons to glide smoothly in the covering sheath, leading to pain and restricted movement. There are a number of factors that can increase a person’s risk of developing DeQuervain’s Tenosynovitis. These include:
- Repetitive activities requiring sideways or twisting movements of the wrist while gripping the thumb (eg. Hammering, racquet sports, fishing, chefs)
- Unaccustomed tasks involving the thumb such as a new mother repetitively lifting or carrying a baby
- Rheumatoid arthritis
- Injury to the thumb or wrist, such as with a heavy blow or knock
- Females are 6-10 times more likely to experience tenosynovitis
- Age (30-40 years or over)
Signs and Symptoms
- Pain and/or swelling on the thumb side of the wrist
- Pain on stretching or flexing the thumb, particularly when the thumb and wrist are moved together
- Flicking or snapping sensation may occur with movement
- Tenderness to touch over the back of the thumb
- Difficulty gripping or holding objects
The initial aim of treatment is to reduce associated pain and inflammation. Treatment and management options include:
- Sufficient rest from aggravating activities, particularly those involving repetitive wrist or thumb movement
- Bracing or splinting of the wrist and thumb
- Reduce inflammation through rest, ice, compression, elevation and physiotherapy.
- Pain relief and anti-inflammatory medication as recommended by a doctor or pharmacist
- Physiotherapy- massage, ultrasound, ice therapy, joint mobilisation and stretches
- Range of movement exercises, stretching and strengthening
- Education and advice regarding activity modification or technique correction to avoid recurrent injury.
If symptoms persist after a period of conservative management and physiotherapy, a corticosteroid and anaesthetic injection into the tendon sheath may be considered. Surgery is occasionally required to relieve pressure over the affected tendons. This is usually considered if symptoms have not subsided after approximately three months. Physiotherapy or occupational therapy will be required post-surgery to ensure full recovery and return to activity is achieved.
Return to Activity
Most individual’s respond well to non-surgical treatment and injections. Approximately 50-80 percent of people fully recover following an injection. A small number of people are left with some numbness over the thumb post-surgery, however most make a full recovery and return to activity.