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by Polsdorfer R

De Quervain's Tenosynovitis

(De Quervain’s Syndrome; De Quervain’s Disease; Washerwoman’s Sprain)

Definition

De Quervain's tenosynovitis is an irritation of tendons that run from the wrist to the thumb. These tendons pass through a tunnel-like tissue, called a sheath, at the wrist. The tunnel area can cause additional pressure and irritation on thickened or swollen tendons, making normal movements very painful.
De Quervain's Tenosynovitis
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Causes

De Quervain’s is caused by pressure on already irritated tendons as they move through the sheath at the wrist. The irritation of the tendon may be caused by repetitive movements of the thumb and wrists or a direct blow to the area.

Risk Factors

De Quervain's tenosynovitis is more common in women. Activities that may increase your chance of getting de Quervain's tenosynovitis include:
  • Knitting and needlepoint
  • Lifting a baby or young child often
  • Bowling or wrestling
  • Jobs involving twisting of the wrist or driving of screws
  • Excessive gaming that involves small movements of thumb or texting

Symptoms

Symptoms may include:
  • Pain or tenderness at the base of the thumb
  • Pain when pinching
  • Swelling over the thumb side of the wrist
  • A snapping or catching sensation when moving the thumb
  • Numbness on the back of the thumb, spreading to the index finger

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done and your doctor will ask you to move your fingers and wrists in different ways to help make the diagnosis.
Your doctor may ask you to make a fist with your thumb inside your fingers and bend your wrist toward your little finger. If this causes pain at the wrist below your thumb, you may have de Quervain's tenosynovitis.

Treatment

The goal of treatment is to relieve pain and help you regain function. Initial steps to reduce swelling and irritation include:
  • Resting the thumb and wrist
  • Applying ice
  • Avoiding activity that causes the pain
  • A thumb splint to support and allow the wrist to rest
  • Medication such as nonsteroidal anti-inflammatory drugs (NSAIDs)
If conservative treatments above does not provide adequate relief, your doctor may recommend:
  • Cortisone injection—a cortisone medication is injected into the area to reduce swelling
  • Surgery—if all else fails, surgery may be done to open the tunnel that the tendon is passing through

Prevention

To help reduce the chances of getting de Quervain's:
  • Minimize repetitive thumb activity, or twisting and gripping activities
  • Reduce stress on you hands through ergonomic practices at work

RESOURCES

American Academy of Orthopedic Surgeons
http://orthoinfo.org
American College of Sports Medicine
http://acsm.org

CANADIAN RESOURCES

Canadian Orthopaedic Association
http://www.coa-aco.org
Canadian Physiotherapy Association
http://www.physiotherapy.ca

References

Best treatment for de Quervain's tenosynovitis uncertain. Am Fam Physician. 2003;68(3):536.
Corticosteroid injection for treatment of de Quervain's tenosynovitis: a pooled quantitative literature evaluation. J Am Board Fam Pract. 2003;16(2):102-106.
de Quervain syndrome. Merck Manual for Health Care Professionals website. Available at: http://www.merckmanuals.com/professional/musculoskeletal%5Fand%5Fconnective%5Ftissue%5Fdisorders/hand%5Fdisorders/de%5Fquervain%5Fsyndrome.html. Updated March 2013. Accessed February 28, 2014.
de Quervian tendinitis (de Quervian tendinosis). American Academy of Orthopaedic Surgeons Ortho Info website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00007. Updated December 2013. Accessed February 28, 2014.
de Quervain tenosynovitis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated July 10, 2013. Accessed February 28, 2014.
Johnson CA. Occurrence of de Quervain's disease in postpartum women—pain and tenderness in wrist. J Fam Pract. 1991 Mar;32(3):325-327.

4/30/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Petit Le Manac'h A1, Roquelaure Y, Ha C, Bodin J, Meyer G. Risk factors for de Quervain's disease in a French working population. Scand J Work Environ Health. 2011 Sep;37(5):394-401.

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