De Quervain's Syndrome: Causes, Diagnosis, and Treatment

De Quervain's tenosynovitis is also known as de Quervain's tendinitis, de Quervain's syndrome, or simply de Quervain's. It is a condition that typically develops from repetitive movement, also known as cumulative trauma. The tendons and their covered sheaths swell, leading to friction and pain with movement.

A bit of anatomy

A tendon is a band of connective tissue containing collagen, one of the body's structural proteins. Tendons connect muscles to bones.

As shown in the image above, the wrist and thumb tendons normally move back and forth in a tunnel created by the extensor retinaculum, a fibrous firm type of connective tissue. When the tendons are irritated, the surrounding sheaths become inflamed, leading to friction when moving back and forth through the retinaculum.

Causes of de Quervain's

As mentioned above, swelling of the tendons and tendon sheaths causes friction with movement inside the extensor retinaculum. The exact cause of the swelling of the tendons and tendon sheaths is unknown. However, it is believed to be thick tissue deposits and increased blood flow. It does not appear to be an inflammatory process, the body's usual response to injury or infection.

De Quervain’s can be caused by any activity that involves repetitive wrist or thumb movement can lead to de Quervain's syndrome, including:

• Sports like racquetball, tennis, or golf.
• Occupations that involve using a screwdriver or hammer.
• Hobbies like gardening or sewing.
• Mothers with newborn babies since carrying the baby requires using the wrist, hence, the term “mommy's thumb.”

Other causes of De Quervain’s can be:

• Trauma to the wrist can lead to de Quervain's syndrome because it causes scar tissue to form on the tendons.
• Inflammatory conditions like rheumatoid arthritis.
• Pregnancy causes fluid retention and can lead to de Quervain's.

Symptoms of de Quervain's

The following are symptoms of de Quervain's syndrome:

• Pain and swelling at the thumb side of the wrist or the base of the thumb.
• Pain exacerbated by movement and relieved by rest.
• Pain is aggravated by grasping or pinching (some people first feel the pain when opening a jar).
• A popping sensation with thumb or wrist movement.

Diagnosing de Quervain's

A physician will take a history and look for the symptoms mentioned above. In addition, your occupation and hobbies may give a clue to the diagnosis.

Physical exam

Your physician will look at your hand and wrist. They will observe for swelling or tenderness at the base of the thumb and thumb side of the wrist. Your physician will check the range of motion and see if there is any popping with movement.

A special test called Finkelstein's test is shown above. For this test, the thumb is placed inside a closed fist, and the wrist is forcibly deviated downwards. If much pain results, it is considered a positive test for de Quervain's syndrome.

Imaging studies

Plain x-rays will not show the tendons or their sheaths. Still, they will allow the physician to view the bones to evaluate for any underlying bony abnormalities, such as fractures, arthritic changes, or osteoporosis.

Sometimes, a more detailed imaging study is needed. In that case, a magnetic resonance imaging (MRI) test can be done to allow visualization of the bones, tendons, muscles, and ligaments, which connect bones to other bones.

Additionally, an ultrasound test that uses sound waves can help visualize tendon swelling. This is a practical test because it allows the examiner to see the movement of the tendons in real-time.

Treating de Quervain's

While some cases of de Quervain's resolve by avoiding the aggravating activity, others require non-surgical treatment, though some rare cases require surgery.

Wrist braces

For de Quervain's syndrome, the ideal brace will protect and support both the wrist and thumb. The brace can be firm to allow no movement, or soft to enable some movement. Some people respond better to firm braces, others respond better to soft braces, and some respond best to a combination, like using a soft brace during the day and a firm one at night or vice versa.

Hot and cold therapy

Just like braces, each person responds differently to ice and heat. For example, some respond better to ice, while others respond better to heat. Ideally, heat can be used before wrist activity to loosen up the tendons and muscles, while ice can be used after activity to decrease swelling.

Medications

Over-the-counter pain meds like acetaminophen (Tylenol) can help with short-term pain relief, but can cause liver issues if used long-term. Non-steroidal anti-inflammatory medications can also reduce swelling. However, they must be used cautiously since prolonged use can lead to an ulcer or irritate the stomach lining.

Other treatments

There are other treatments options available for de Quervain's syndrome, including the following:

• Occupational (hand) therapy. An occupational therapist can help with posturing, exercises, stretching, and using modalities like electrical stimulation.
• Injections. Cortisone injections directly into the tendons can be helpful. Sometimes an ultrasound is needed to guide the needle to the exact location.
• Surgical treatment. A surgical procedure can be done as an outpatient. Many hand surgeons do the surgery in their offices. For these surgeries, a small cut is made in the sheath, which opens it and allows the tendon to move more freely.

Understand that de Quervain’s is a type of tendonitis, usually caused by repetitive trauma. With prompt diagnosis and treatment, the symptoms can resolve very quickly.