DeQuervain's Tenosynovitis

The Problem

DeQuervain’s tenosynovitis is a painful inflammatory condition of the lining of tendons at the back of the thumb and the thumb side of the wrist.  When inflammation develops, extra friction is generated within the narrow sheath through which these two tendons must pass.  The result is painful limited motion at the wrist, especially with forceful gripping, grasping or twisting.

The condition is the result of overuse, particularly with forceful gripping while flexing and extending the wrist.  It may also occur with direct trauma and is more common in patients with diabetes, rheumatoid arthritis or other inflammatory conditions.

Symptoms

Pain, swelling or tenderness are usually present on the thumb side of the wrist.  Pain may radiate into the thumb or the lower forearm.  Pain is typically increased by gripping or grasping and motion of the thumb may be painful or restricted.  The area is often tender.  Pain can be provoked by having the patient tuck the thumb into the fist and then bending the wrist towards the little finger side of the wrist.

Treatment

Treatment is focused on decreasing local pain and inflammation.  This may be achieved by applying ice, taking non-steroidal anti-inflammatory drugs, or by splinting to immobilize the wrist and thumb.  Movements that increase pain should be avoided.  Steroid medication can be injected alongside the tendon sheath to decrease pain and inflammation.

Although most cases are successfully treated without surgery, operative treatment is considered when the problem does not respond to non-surgical methods over time.  Surgery is performed to open the sheath to create more room for the affected tendons, thereby eliminating a major source of inflammation.