In this short video, hand and upper extremity specialist, Dr. Christopher Healy, addresses the common causes, symptoms, and treatment options for a common painful wrist condition called de Quervain’s tenosynovitis.
Thumb anatomy
Located at the base of the human thumb are tendons that control the thumb. Tendons are rope-like structures that attach the muscle in your thumb to bone. Located on the thumb side of the wrist, two of the main tendons in the thumb pass through a tunnel, or series of pulleys. In order for these tendons to slide through their appropriate tunnel, a soft, slippery tissue layer called synovium covers the tendons. This tissue layer allows tendons to slide easily through a fibrous tunnel called a sheath.
What causes de Quervain’s tenosynovitis?
“De Quervain’s tenosynovitis is a mouthful, but basically what it refers to is a type of tendonitis on the thumb side of your wrist,” says hand and upper extremity specialist, Dr. Christopher Healy. “Patients usually get it from overuse, doing the same type of motion over and over again.” Another common name for the condition is de Quervain’s tendinosis, which refers to a swelling of the tendons. Someone suffering from de Quervain’s tenosynovitis experiences pain because the tendons in their thumb have become inflamed and swollen. This inflammation in the tendon keeps it from sliding through its appropriate tunnel as it typically would – smoothly and with ease.
Is “Mommy’s Wrist” de Quervain’s tenosynovitis?
Mothers and caregivers of young children can often suffer from “mommy’s wrist” or “mommy’s thumb” which is the same thing as de Quervain’s tenosynovitis. Younger women with the condition have often recently given birth or are breastfeeding. It is also common in women in their fifties and sixties.
What are the symptoms of de Quervain’s tenosynovitis?
The type of pain a patient experiences with de Quervain’s is pain specific to one corner of the wrist and can appear gradually or suddenly. It is particularly noticeable when forming a fist, grasping or gripping something, or when turning the wrist. Other common symptoms can include:
- Pain felt over the thumb side of the wrist. Pain can travel up the forearm and is usually worse when the hand and thumb are in use.
- Swelling over the thumb side of the wrist. This swelling may accompany a fluid-filled cyst in this region.
- A “catching” or “snapping” sensation may be felt when moving the thumb.
- Pain and swelling may make it difficult to move the thumb and wrist.
Treatment options for de Quervain’s tenosynovitis
While there isn’t much that can be done to prevent de Quervain’s, usually the symptoms can be treated non-surgically.
Conservative treatment options for de Quervain’s tenosynovitis can include:
- Thumb splinting
- Hand therapy
- Adjusting the way you use your hand and wrist
- NSAIDs – anti-inflammatories such as ibuprofen and Tylenol
- Corticosteroid injections
- Ice/heat packs
- Massage
- Stretching
“We only do surgery for de Quervain’s if we’ve exhausted all of the non-operative treatment options and they haven’t worked. Conservative treatment options should be tried for at least six months before jumping to surgery options,” says Dr. Healy.
Surgical treatment generally involves opening up the thumb compartment (covering) to make room for the irritated tendons.
By treating de Quervain’s either non-surgically or surgically, normal use of the hand usually can be resumed once comfort and strength have returned.
Helpful stretches and exercises for de Quervain’s tenosynovitis
Stretching muscles in the thumb can help relax and lengthen the tight muscles in the thumb, as well as improve range of motion. Increasing strength in the thumb can also help prevent and alleviate painful symptoms. Strength exercises for the thumb that can help decrease inflammation, improve function, and prevent recurrence include:
- Thumb lifts
- Opposition stretch (repeatedly bringing your thumb and pinky finger together to touch)
- Thumb flexion
- Finkelstein stretch
- Wrist flexion
- Wrist extension
- Wrist radial deviation strengthening
- Eccentric radial deviation strengthening
- Grip strengthening
- Finger spring
If you have taken steps to help reduce the pain in your wrist and it is still not getting better, you should be seen by a doctor who specializes in hand and upper extremity conditions. A specialist can exam your wrist and take you through a diagnosis, explain what’s going on with your wrist, and explore promising options that will help resolve your wrist pain.
Common hand conditions
The hand and wrist are made up of an extremely complex structure of joints, bones, and muscles and are engaged almost constantly in daily life. When function is limited by an injury or disease, it’s important to see an orthopedic hand specialist promptly to evaluate and treat the condition. Our hand and upper extremity (arm below the shoulder) team of fellowship trained orthopedic surgeons and physician assistants work together to diagnose and treat conditions to get you back to what you love doing.
Thumb Arthritis – Arthritis at the joint at the base of the thumb, or the carpalmetacarpal (CMC) joint is very common. When osteoarthritis occurs at this joint, the cartilage begins to wear down creating painful bone on bone friction.
Trigger Finger – Trigger finger occurs when the flexor tendon becomes irritated and begins to thicken, eventually creating nodules making it difficult for the joint to bend and straighten. When the tendon is lengthening, it becomes momentarily stuck then quickly pops out into extension.
Dupuytrens Contracture – Dupuytren’s Contracture develops when the fibrous tissue layer underneath the palm and fingers begins to thicken. Small bumps form under the skin and may lead to the fingers contracting and curling in.
Carpal Tunnel – Carpal Tunnel Syndrome is a common condition that causes pain, numbness, and tingling in the hand and wrist. This is caused when the area around the main nerve, called the carpal tunnel, becomes compressed.
For a complete list of common hand and wrist conditions, visit our services page.
Our hand and upper extremity specialists at The Center in Bend, Oregon use conservative, evidence based approaches to treat hand and wrist disorders like dupuytren’s, carpal tunnel syndrome, trigger finger, nerve injuries, and complex hand and wrist fractures. Our team is comprised of the highest trained and skilled hand surgeons in Central Oregon.
To make an appointment with one of our orthopedic specialists, call 541.322.2352, or request an appointment here.
