deQuervain's Tendinitis

Definition: De Quervain’s tendinitis, also known as de Quervain’s tenosynovitis, is a painful condition affecting the tendons on the thumb side of the wrist. It involves inflammation of the sheath (the synovium) that surrounds the two tendons that control the movement of the thumb.

Causes:

• Repetitive Hand or Wrist Movements: Activities that require repetitive thumb motions, such as typing, texting, playing certain sports, or lifting a child.
• Direct Injury: Trauma to the wrist or tendon can lead to swelling and restrict tendon movement.
• Inflammatory Conditions: Conditions like rheumatoid arthritis can increase the risk of developing de Quervain’s tendinitis.

Symptoms:

• Pain and tenderness along the thumb side of the wrist, which may radiate into the forearm
• Swelling near the base of the thumb
• A “sticking” or “stop-and-go” sensation in the thumb when moving it
• Difficulty with movements that involve grasping or pinching
• Pain that worsens with thumb or wrist movement

Diagnosis:

• Physical Examination: Assessing pain, swelling, and tenderness along the thumb side of the wrist.
• Finkelstein Test: The patient makes a fist with the fingers closed over the thumb and bends the wrist toward the little finger; pain during this maneuver typically indicates de Quervain’s tendinitis.

Treatment:

1. Non-Surgical Treatments:

   • Rest and Immobilization: Wearing a splint or brace to immobilize the thumb and wrist, allowing the tendons to heal.
   • Ice Therapy: Applying ice packs to reduce pain and swelling.
   • Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve pain and reduce inflammation.
   • Corticosteroid Injections: Injecting corticosteroids into the tendon sheath to reduce inflammation and pain.

2. Physical Therapy:

   • Exercises: Stretching and strengthening exercises for the thumb and wrist to improve flexibility and reduce symptoms.
   • Ergonomic Training: Adjustments to reduce strain on the wrist and thumb during activities.

3. Surgical Treatments:

   • Surgical Release: In severe or persistent cases, surgery may be performed to release the sheath around the tendons, reducing pressure and allowing the tendons to glide more freely.

Prognosis: With appropriate treatment, most individuals with de Quervain’s tendinitis experience significant relief from symptoms and can return to normal activities. Early intervention is crucial to prevent the condition from becoming chronic. Adhering to treatment plans, including rest, physical therapy, and ergonomic adjustments, can help manage and prevent recurrence of the condition.