DE QUERVAIN’S TENOSYNOVITIS

If you suffer from chronic pain or weakness related to Tenosynovitis, don’t hesitate to Schedule an appointment with one of our orthopedic specialists.

A painful condition of the wrist, De Quervain’s tenosynovitis (dih-kwer-VAINS ten-oh-sine-oh-VIE-tis) affects the tendons on the thumb side of your wrist. If you have de Quervain’s tenosynovitis, the wrist will hurt when you rotate it, grasp objects or make a fist.

Although physicians do not know the exact cause of De Quervain’s Tenosynovitis, any activity that applies repetitive movement to the hand or wrist — such as yard work, golf, racket sports, or lifting children — can make it worse.

De Quervain’s Symptoms

Pain and swelling at the base of the thumb make grasping or pinching objects difficult, significantly impacting daily activities. Patients often experience a “sticking” sensation when moving the thumb, adding to the discomfort and hindering smooth motion. If untreated, the condition worsens, spreading pain into the forearm. Movements involving pinching and grasping become increasingly painful, affecting tasks such as writing, holding utensils, or using tools. Early intervention is crucial to prevent progression and manage symptoms effectively.

De Quervain’s Conservative Treatment

To manage pain and swelling in the affected thumb, avoid using the thumb to prevent further strain and promote healing. Applying cold packs to the painful area reduces inflammation and provides temporary relief. Use the cold compress for 15-20 minutes several times a day. Additionally, take nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen as directed to alleviate pain and reduce inflammation. These medications help manage symptoms and improve comfort. Combining these strategies can effectively control pain and swelling, aiding in the recovery process and preventing the condition from worsening.Causes

Physicians determine Chronic overuse of the wrist as the most common cause of De Quervain’s tenosynovitis.

When you grip, grasp, clench, pinch or wring anything in your hand, the tendons in your wrist and lower thumb normally glide smoothly through the small tunnel that connects to the base of the thumb. Repetitively making the same motion on a daily basis can irritate the sheath around the wrist tendons, which causes them to thicken and swell, which restricts their movement.

Other possible causes can include:

• Scar tissue in the wrist due to a direct injury to the tendon
• Inflammatory arthritis, such as rheumatoid arthritis

De Quervain’s Risk factors

If you line up with any of the following, you could have a higher risk of presenting with De Quervain’s Tenosynovitis. 

Individuals aged 30 to 50 have a higher risk of developing De Quervain’s tenosynovitis compared to other age groups. Women more commonly experience this condition than men. Pregnancy frequently accompanies De Quervain’s tenosynovitis, likely due to hormonal changes and fluid retention that increase the vulnerability of the tendons. Baby care activities, such as repeatedly lifting a baby, place significant leverage on the thumbs, contributing to the development of this condition.

Jobs or hobbies that involve repetitive hand motions also elevate the risk of De Quervain’s tenosynovitis. Activities like typing, knitting, gardening, or playing certain musical instruments stress the tendons in the thumb and wrist. Repeated stress and overuse can lead to inflammation and pain characteristic of this condition. Understanding these risk factors can help individuals take preventive measures, such as proper hand ergonomics and regular breaks during repetitive tasks, to minimize the likelihood of developing De Quervain’s tenosynovitis.

De Quervain’s Release Surgery 

Hand and Wrist Specialists can perform a “De Quervain’s release”, an outpatient procedure to relieve the symptoms of De Quervain’s tenosynovitis. This procedure releases the sheath of the tendon that wraps around the base of the thumb, which relieves pressure and friction. De Quervain’s release surgery allows the tendons to glide freely once again when moving the thumb and wrist.

During a De Quervain’s Release surgery, the hand surgeon makes a small incision near the base of the thumb on the wrist. The surgeon then locates the inflamed tendon and makes a small slit in the sheath surrounding the tendon, releasing it. This allows the tendon sheath to open wider and relieves pain by releasing pressure and friction within the tendon.

After the surgery, the hand surgeon will close the incision with sutures, bandages, and then apply a splint. As an outpatient procedure, Patients will go home from the hospital the same day as the operation. 

De Quervain’s Release Recovery 

Recovering from De Quervain’s release surgery involves a series of carefully monitored steps to ensure optimal healing and the return of hand function. Initially, patients should keep the surgical area clean and dry, following the doctor’s instructions for wound care. Immobilization with a splint or bandage helps protect the thumb and wrist while the tissues heal.

Pain and swelling are common in the early stages, and patients can manage these symptoms with prescribed pain medications and ice packs. Gradually, under the guidance of a physical therapist, patients can begin gentle range-of-motion exercises to restore mobility and strength to the thumb and wrist.

Regular follow-up appointments with the surgeon are essential to monitor the healing process and address any concerns. Most patients experience significant relief from pain and an improvement in hand function within a few weeks to months. Adhering to the recommended recovery protocols ensures a smoother recovery and reduces the risk of complications or recurrence.

If you would like to speak to a precision orthopedic hand and wrist specialist, give us a call at 817-697-4038, or contact us over the web. Tele-medicine appointments are also available.