De Quervain’s Tenosynovitis

De Quervain’s tenosynovitis, also known as de Quervain’s syndrome and de Quervain’s disease, is a condition that causes inflammation of the tendons on the side of the wrist at the base of the thumb.  The swollen tendons rub against the narrow tunnel they pass through, causing pain to radiate into the lower arm.  It is commonly known as ‘gamer’s thumb’ as it is often seen in computer gamers who spend long periods of time playing.

Causes of de Quervain’s Tenosynovitis

De Quervain’s tenosynovitis is typically brought on by a strain injury to the extensor pollicis longus and abductor pollicis tendons (tendinitis), often caused through repetitive motion injury.  Common causes include:

• Lifting heavy bags by the loops
• A direct blow to the thumb
• Lifting young children into car seats
• Hobbies such as gardening or sporting activities
• Excessive gaming
• Repetitive workplace tasks

Risk factors for de Quervain’s tenosynovitis include:

• Pregnancy and early motherhood
• Inflammatory conditions like rheumatoid arthritis
• Adults between the ages of 30-50 are more susceptible
• African ethnicity / descent
• Females are 8-10 times more likely to get it than men are

Symptoms of de Quervain’s Tenosynovitis

The primary symptoms of de Quervain’s Tenosynovitis is pain on the side of the wrist at the base of the thumb, with pain sometimes radiating up the forearm, depending on the severity of the condition.  Pain can be gradual or come on suddenly and will usually feel worse when using the thumb to grab something, or when twisting the wrist.  Common symptoms include:

• Swelling and tenderness at the location of pain
• Pain directly under the thumb at the level of the wrist
• A catching or grinding sensation when you try to move your thumb and wrist

Diagnosing de Quervain’s Tenosynovitis

De Quervain’s tenosynovitis is generally straightforward to diagnose as it is based on the appearance and location of pain.  Your doctor will carry out a physical examination by placing pressure on the thumb and side of your wrist over the involved tendons.  This will help assess the level of pain.

One specific method used is the Finkelstein test.  You will be asked to bend your thumb across your palm, and then flex your fingers over your thumb to make a fist.  The movement stretches the tendons, and if you experience any pain on the thumb and side of the wrist, it is a good indication that you have de Quervain’s tenosynovitis.

Imaging tests are generally not required to make a proper diagnosis; however, your doctor may request an X-ray or MRI scan to ensure the alignment of the wrist joint is normal and there are no signs of arthritis within the wrist; another common reason why people experience pain in this region of the hand.

Treatment for de Quervain’s Tenosynovitis

Your doctor will attempt conservative (non-surgical) methods of treatment before considering surgery.  The aim is to alleviate the pain and inflammation when moving the thumb and a combination of rest, ice, splinting and anti-inflammatory medication usually works best.

Medication

Over the counter painkillers such as ibuprofen works well in easing pain and discomfort, although your doctor may recommend a cortisone (steroid) injection if you see little improvement from over the counter treatments.  Steroid injections are extremely effective and are generally considered the best non-surgical treatment for de Quervain’s tenosynovitis.  Normal activities can be resumed within 3 weeks after the injection.

Splinting

A splint is worn continuously, day and night for 4-6 weeks to support the thumb and wrist.  Resting the thumb and wrist will avoid carrying out tasks that are causing the pain.  This is often used in conjunction with cortisone injections.

Physiotherapy

Physical therapy will help teach you exercises to strengthen the wrist, hand and arm.  It is important that you carry them out regularly, as advised by your physiotherapist in order to see the best results.

Surgery for de Quervain’s Tenosynovitis

If your doctor feels that conservative treatments are not giving you enough pain relief, the option of surgery will be discussed with you.

The procedure is performed under a local anaesthetic so the affected area is numb and you will not feel any pain.  It can be performed under a general anaesthetic if the surgeon feels this is a better option for you. Again, this will be discussed prior to surgery.

The surgeon will make a small incision in the sheath around the swollen tendon to release the restriction of the tendon motion.  This provides the tendons more room to move.  If any inflamed tissue or small cysts are found, they will be removed at the same time.  Once the surgery is complete, the incision will be stitched or stapled, and covered with a small dressing and a splint.

Surgery is performed as an outpatient procedure so you can return home the same day. It is advisable that you have someone to drive you home.

Post-Operative Recovery

Recovery from surgery can take a number of weeks, although your pain and swelling should go away fairly soon after your procedure.  However, the area can remain tender for several months.  You will need to wear the splint for 2-4 weeks to allow the wrist time to heal.  You will be given a set of exercises to perform to help strengthen your wrist and thumb, improve range of motion and restore functionality.  You will be expected to carry them out for approximately 6-8 weeks, or until you feel you have gained enough strength and stability in the affected area.

You can usually resume normal activities within a few weeks, provided there are no complications.

Prognosis

The prognosis for de Quervain’s tenosynovitis after surgery is excellent provided you follow your recovery plan. Full function of the thumb and wrist usually returns once the inflammation has subsided. Your doctor may recommend you wear a brace for future activities that involve repetitive wrist motion.

Need Help?

At One Healthcare we can book you in to see a specialist Orthopaedic Hand and Wrist surgeon, usually within 48 hours, for an initial consultation. Treatment for de Quervain’s tenosynovitis is available at One Ashford Hospital in Kent and One Hatfield Hospital in Hertfordshire.

You can use your private medical insurance or pay for your De Quervain’s Tenosynovitis treatment. We offer competitive, fixed price packages. If you are using your health insurance, please contact your insurer first for approval and let them know you’d like to be treated at either the One Ashford Hospital or One Hatfield Hospital.

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• Modern purpose-built hospital opened in March 2016 (Ashford) December 2017 (Hatfield)
• Fast access to diagnostics including MRI, X-ray and Ultrasound
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• Little or no waiting time
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