De Quervain's tenosynovitis is a condition of the tendons involved in thumb movement. It is relatively common, and can cause pain and sensitivity on the side of your wrist leading to your thumb. Movements that involve moving your thumb, rotating your wrist, or bending at the wrist in certain directions can exacerbate the pain. Treatment for de Quervain's tenosynovitis may involve non-surgical interventions or surgery, and aims to restore pain-free function of your wrist and hand.
De Quervain’s tenosynovitis is an inflammatory condition of the two tendons that control movement of your thumb, resulting in pain and a restricted range of motion. These two tendons originate from muscles in your forearm, and are enclosed in a sheath known as synovium, all of which pass through a tunnel made of bone and fibrous tissue as they travel through the wrist into your hand.
Irritation and inflammation of these tendons cause the synovium to swell, interfering with its ability to slide smoothly through the tunnel. De Quervain’s disease is most commonly associated with chronic overuse of your wrist, such as lifting children, playing piano, or other activities that involve repetitive grasping or rotational wrist movements.
Women in general are more susceptible to de Quervain’s tenosynovitis when compared to men, with an estimated prevalence of 1.3% and 0.5% respectively. The condition also tends to be more prevalent in individuals:
The predominant symptom of de Quervain’s tenosynovitis is pain on the thumb side of your wrist. This pain tends to be worse when engaging in the same wrist and hand motions that likely caused the injury in the first place – gripping objects, lifting from the wrist, or twisting your wrist.
Other signs and symptoms of de Quervain’s can include:
Treatment for de Quervain’s normally starts with conservative, non-surgical treatments before escalating to surgery if necessary. All approaches to treatment are aimed at improving the function of your wrist and thumb and alleviating the pain associated with movement.
When making a diagnosis of de Quervain’s tenosynovitis, your orthopaedic specialist will perform a physical exam of your wrist, which may reveal tenderness and swelling over the two tendons in your wrist involved in thumb movement. You may be asked to perform gentle wrist movements to confirm the location of the pain and which types of motion exacerbate it. X-ray scans and other imaging are not typically required to diagnose de Quervain’s, but may be needed to exclude other conditions that present with similar symptoms, such as arthritis of the base of the thumb.
The vast majority of individuals with de Quervain’s tenosynovitis will find relief from their symptoms with non-surgical treatment. Often, a combination of these strategies is the most effective.
Non-surgical interventions include:
If conservative, non-surgical de Quervain’s treatments do not result in an improvement in your symptoms and wrist function after 4-6 weeks, surgery may help, though this is not often required. de Quervain’s surgery is highly effective at managing these cases unresponsive to conservative measures, with success rates of around 95%.
Surgery for de Quervain’s tenosynovitis is aimed at releasing the synovium sheath to alleviate pressure on the tendons and relieve inflammation and irritation. In the hands of an experienced orthopaedic hand and wrist surgeon, this can be achieved without destabilising the tendons or affecting your hand and wrist function. During the post-operative recovery period, you may need to wear a splint to support healing.
