De Quervain’s Disease
DE QUERVAIN’S DISEASE
De Quervain’s tenosynovitis is a painful condition affecting the tendons on the thumb side of your wrist. If you have de Quervain’s tenosynovitis, it will probably hurt when you turn your wrist, grasp anything or make a fist.
Although the exact cause of de Quervain’s tenosynovitis isn’t known, any activity that relies on repetitive hand or wrist movement — such as working in the garden, playing golf or racket sports, or lifting your baby — can make it worse.
HAND & WRIST ANATOMY
Pain near the base of your thumb
Swelling near the base of your thumb
Difficulty moving your thumb and wrist when you’re doing something that involves grasping or pinching
A “sticking” or “stop-and-go” sensation in your thumb when moving it
Chronic overuse of your wrist is commonly associated with de Quervain’s tenosynovitis.
Tendons are rope-like structures that attach muscle to bone. When you grip, grasp, clench, pinch or wring anything in your hand, two tendons in your wrist and lower thumb normally glide smoothly through the small tunnel that connects them to the base of the thumb. Repeating a particular motion day after day may irritate the sheath around the two tendons, causing thickening and swelling that restricts their movement.
Other causes of de Quervain’s tenosynovitis include:
Direct injury to your wrist or tendon; scar tissue can restrict movement of the tendons.
Inflammatory arthritis, such as rheumatoid arthritis.
Treatment for de Quervain’s tenosynovitis is aimed at reducing inflammation, preserving movement in the thumb and preventing recurrence.
If you start treatment early, your symptoms should improve within four to six weeks. If your de Quervain’s tenosynovitis starts during pregnancy, symptoms are likely to end around the end of either pregnancy or breast-feeding.
To reduce pain and swelling, the doctor may recommend using over-the-counter pain relievers, such as ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve).
The doctor may also recommend injections of corticosteroid medications into the tendon sheath to reduce swelling. If treatment begins within the first six months of symptoms, most people recover completely after receiving corticosteroid injections, often after just one injection.
Initial treatment of de Quervain’s tenosynovitis may include:
Immobilizing your thumb and wrist, keeping them straight with a splint or brace to help rest your tendons
Avoiding repetitive thumb movements as much as possible
Avoiding pinching with your thumb when moving your wrist from side to side
Applying ice to the affected area
You may also see a physical or occupational therapist. These therapists may review how you use your wrist and give suggestions on how to make adjustments to relieve stress on your wrists. Your therapist can also teach you exercises for your wrist, hand and arm to strengthen your muscles, reduce pain and limit tendon irritation.
If your case is more serious, the doctor may recommend outpatient surgery. Surgery involves a procedure in which the doctor inspects the sheath surrounding the involved tendon or tendons, and then opens the sheath to release the pressure so your tendons can glide freely.
The doctor will talk to you about how to rest, strengthen and rehabilitate your body after surgery. A physical or occupational therapist may meet with you after surgery to teach you some new strengthening exercises and help you adjust your daily routine to prevent future problems.
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