Thumb Tendonitis (De Quervain’s Tenosynovitis)
What is De Quervain’s tenosynovitis?
De Quervain’s tenosynovitis, also called De Quervain’s tendinosis, is the medical name for thumb tendonitis. It is inflammation of the thumb tendons, caused by entrapment or irritation of the tendons in the wrist at the base of the thumb. When the tendons become inflamed, they swell causing pain, tenderness and weakness, especially when grasping, gripping or creating a fist.
Entrapment is when the two primary thumb tendons that pass through a tunnel on the thumb side of the wrist, swell which increases friction and causes pain.
What causes thumb tendonitis?
The exact cause is unknown but involves a thickening of the tendon sheath, painfully entrapping the tendons. It is associated with repetitive thumb and wrist motions and may be activated by activities like racquet sports or golf; or by motions like squeezing, pinching, gripping and wringing.
It is common in mothers of newborns who are repeatedly lifting a newborn with their thumbs abducted (the thumb is moved away from the hand and fingers as if preparing to shake hands). Thumb tendonitis is estimated to affect 0.5% of men and 1.3% of women primarily in their thirties and forties.
A previous injury or surgery can cause the tendon tunnel to narrow increasing the risk of thumb tendonitis.
What are the symptoms of thumb tendonitis?
Symptoms include pain at the base of the thumb on the outside of the wrist that worsens with thumb and wrist motion. This pain can make simple every day activities such as opening a jar lid painful and difficult. Other symptoms may include swelling, thumb and wrist stiffness, and difficulty grasping or lifting an object.
How is thumb tendonitis diagnosed?
Diagnosis is clinical. Your Ortho Illinois hand expert will ask about your medical history, your symptoms, when they started and what causes them. They will examine your thumb and wrist and ask you to complete some tests that require you to move your thumb and wrist in different directions. If these simple movements cause pain on the thumb side of your wrist, it will help to confirm thumb tendonitis. X-rays may be helpful to differentiate this condition from another source of wrist pain.
How is thumb tendonitis treated?
Often the condition resolves without medical intervention, with home treatments such as over the counter anti-inflammatory medications, rest, ice and heat, and activity modification.
When symptoms persist, splinting, oral anti-inflammatory medications, acupuncture and corticosteroid injections may be recommended. Splinting alone often fails to provide relief. Steroid injections can provide complete relief. In fact, studies show that about half of patients can experience relief with a single Steroid injection.
When symptoms fail to improve or recur after 2 steroid injections, surgery may be a good option. Nerve decompression surgery for thumb tendonitis is outpatient surgery with local or regional anesthesia. A small incision allows the surgeon to access the compressed nerves and releases them. Surgery is very successful at relieving symptoms and has low complication rates, but it may take a few months for complete recovery. Mild swelling and tenderness may continue for several months. Hand therapy may be recommended to regain function.
When your thumb hurts and you have difficulty performing everyday activities without pain and weakness, it is time to consult the hand experts at Ortho Illinois.
