De Quervain’s Tenosynovitis

What is De Quervain’s Tenosynovitis?

De Quervain’s tenosynovitis is a malady that occurs on the thumb side of the wrist. Specifically, it affects the tendons connecting the extensor pollicis brevis and abductor pollicis longus muscles to the bones of the thumb, which control movement of that digit. Specifically, in De Quervain’s, the tissue lining the first dorsal compartment or tunnel through which these tendons pass becomes inflamed, which impedes smooth movement of the tendons and so inhibits their ability to effectively move and control the motion of the thumb.

What causes it?

De Quervain’s has long been known in layman’s terms as “washermoman’s sprain,” which is indicative of its causes, which are continuous, repetitive, unaccustomed motions. In more recent years, it has taken on many names, which include Mommy Thumb, Gamer’s Thumb, and Blackberry Thumb, which are more clearly indicative of the nature of the illness in relation to modern problems. The first one derives from the occurrence of De Quervain’s in mothers who are breastfeeding. The way that an infant is held during this is what causes the irritation and inflammation. Additionally mother’s frequently lifting their new born under the arm pits while pulling their thumbs outward also may lead to inflammation. The latter two are clearly referencing the occurrence of De Quervain’s in people who engage in long-term use of the thumb in relation to technology, specifically cellular phones, PDAs, and controllers for game consoles. The prefect storm is a working new mother that is also frequently texting or using the keyboard.

Symptoms of De Quervain’s Tenosynovitis

De Quervain’s is apparent in pain, swelling and tenderness in the wrist along the same side as the affected thumb. Trouble with activities that involve thumb movement such as pinching, gripping and grasping can also occur as the condition becomes more advanced.

How do I know if I have De Quervain’s Tenosynovitis?

De Quervain’s is particularly easy to diagnose, specifically by a simple test known as a Finkelstein Test. In this procedure, the hand is closed into a fist with the thumb tucked underneath, and the whole hand is bent away from the thumb side. You will know pretty quickly if this test indicates the presence of De Quervain’s, because the discomfort will be apparent almost immediately, depending on the severity of the issue. It is not uncommon for this to affect both wrists particularly in new mothers.

Treatment of De Quervain’s Tenosynovitis

Non-Surgical Treatment

NSAIDs and a thumb spica splint may be effective in the non-surgical treatment for De Quervain’s. These anti-inflammatories can serve to reduce the swelling on the tendons, allowing for smoother motion of the tendons. If this proves unsuccessful, then the doctor will usually opt to inject your wrist with steroids, which, when paired with splinting, will frequently result in the easing of symptoms and allow you to resume function.

Surgical Treatment

As with many of the procedures done here, the surgery required to relieve advanced De Quervain’s tenosynovitis is minimally invasive. The doctor will enter the affected area through a small incision, similar to that used in the related Endoscopic Carpal Tunnel Release. Once inside the wrist, the first dorsal compartment through which the affected tendons pass is released, or opened up, to relieve pressure on the tendons. After surgery, the wrist is immobilized in a brace for several days followed by exercises. The total recovery time is usually 4-6 weeks.

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