If you suffer from pain on the thumb side of the wrist, you might be experiencing De Quervain’s Tenosynovitis. This condition occurs when the tendons on the thumb side of the wrist become inflamed and cause pain when extending the thumb. This condition is common in mothers with young children who notice pain along the thumb side of the wrist while lifting their child. This blog post will discuss how to identify the symptoms of DeQuervain’s Tenosynovitis, as well as conservative and surgical options.
Tendons are strong rope-like fibers that connect muscles to bones across a joint. Two tendons aid in the extension of the thumb- the Abductor Pollicis Longus (APL) and the Extensor Pollicis Brevis (EPB). These tendons run in a tunnel, called a retinaculum, along the radial (or thumb) side of the wrist. The retinaculum is lined with tenosynovium, a slippery substance allowing tendons to glide back and forth without friction. Inflammation of the tenosynovium is called tenosynovitis, and the associated swelling can hamper the gliding action of the tendons, causing pain.
Causes for this inflammation are not fully understood, but studies show that a change in wrist usage is a predisposing factor. Other factors include repetitive motions such as grasping, pinching, squeezing, or twisting, as well as changes in hormones, swellings caused by rheumatoid arthritis, strain or injury to the wrist, carpentry, or carrying heavy equipment.
Symptoms of De Quervain’s Tenosynovitis include:
- Pain near the base of the thumb especially with pinching or grasping
- Aching near the base of the thumb
- Swelling along the base of the thumb
- Acute pain when extending the thumb
- Reduced grip strength
- Feeling of creaking as the tendons slide
A common test often used to diagnose this condition is Finkelstein’s test. It is done by placing the thumb in the palm, making a fist, and bending the wrist in the direction of the little finger. It’s positive if there’s an increased perception of pain.
Treatment can either be non-surgical or surgical. Conservative or non-surgical treatment for DeQuervain’s tenosynovitis may include:
- Restricting activities that aggravate the tendon of the thumb
- Wearing a supportive splint
- Taking anti-inflammatory medications
- Icing the area
- Steroid injections to reduce inflammation
- Basic exercises may also be recommended to strengthen your muscles, reduce pain, and limit tendon irritation.
If conservative treatment fails, surgery to open the tunnel and release pressure on the tendons may be considered.
Dr. Michael G. McNamara, MD, is a Board-Certified Orthopedic Surgeon with over 25 years of experience in shoulder, elbow, and hand surgery. Dr. Jason R. Gray, MD, is a Board-Certified Orthopedic Surgeon and is Fellowship-Trained in hand, elbow, & shoulder surgery. Dr. Mark T. Caylor, MD, is a Board-Certified Orthopedic Surgeon with 19 years of experience in general orthopedics, sports medicine, and hip & knee reconstruction. Dr. Tyler W. Smith is a Board Eligible Orthopedic Trauma Surgeon who specializes in the treatment of complex fractures, broken bones, and other injuries sustained through traumatic events. Each of our experienced orthopedic specialists are accepting new patient appointments to evaluate and treat orthopedic injuries or conditions. Don’t allow chronic hand or wrist pain stop you from enjoying your active lifestyle. Please visit Alaska Orthopedic Specialists at the MGM professional building, at 4015 Lake Otis Parkway Suite 201. Anchorage, Alaska, 99508, request an appointment here or call (907) 771-3500.