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De Quervain Tenosynovitis Specialist
Dr Poh Seng Yew
MBBS
MRCSEd
MMED (Ortho)
FRCSEd
What is De Quervain Tenosynovitis
De Quervain Tenosynovitis is a condition characterised by pain and swelling in the wrist, specifically in the area where the base of the thumb meets the forearm. It is caused by an inflammation of the synovium, the sheath that surrounds the two tendons responsible for thumb movement. The inflammation increases friction within the tendon sheath, causing pain and limited thumb movement.
De Quervain Tenosynovitis affects individuals engaging in repetitive hand or wrist movements and can also arise post-pregnancy due to hormonal and fluid retention changes.
Symptoms
The primary indicator of De Quervain Tenosynovitis is discomfort in the wrist, specifically near the base of the thumb. Symptoms can include:
- Pain: This is usually the first symptom noticed. The pain may be sharp or dull and is often exacerbated by activities that involve gripping, twisting the wrist, or making a fist. It can start suddenly or gradually and intensify over time.
- Swelling: Swelling or thickening may be observed near the base of the thumb. This might also be accompanied by a fluid-filled cyst in the same region.
- Sensation Changes: A unique ‘sticking’ or ‘snapping’ sensation may occur when moving the thumb, due to the swollen tendons struggling to slide through the sheaths.
- Tenderness: The area over the inflamed tendons, just above the thumb, can become particularly tender and sensitive to touch.
- Radiating Pain: The pain might not be confined to the thumb. It can radiate upwards along the side of the forearm or travel down into the thumb.
- Reduced Mobility: In more severe cases, the pain and swelling may lead to a decrease in the range of motion of the thumb and wrist, making it difficult to perform tasks that require pinching or grasping.
- Numbness: Some individuals may experience numbness in the affected area or along the back of the thumb and index finger.
Causes and Risk Factors
De Quervain Tenosynovitis arises from inflammation of the tendons on the thumb side of the wrist. The exact cause of this inflammation is not always clear, but several factors are known to contribute to its development.
- Repetitive Motion
Repetitive hand or wrist movements, especially those involving gripping, wringing, or similar actions, are a common cause. This is often seen in certain occupations or activities like gardening, playing musical instruments, or typing. - Inflammatory Conditions
Conditions that cause inflammation in the body, such as rheumatoid arthritis, can predispose individuals to this condition. - Hormonal Changes
Hormonal fluctuations, particularly during pregnancy or postpartum, can increase the risk. This is due to changes in fluid retention and tissue elasticity. - Age and Gender
The condition is more common in middle-aged individuals, particularly women. - Trauma or Injury
A direct injury to the wrist or scar tissue formation can lead to the development of De Quervain Tenosynovitis. - Health Conditions
Certain chronic health conditions, like diabetes or obesity, may increase the risk due to systemic inflammation or changes in tissue structure.
Diagnosis
The diagnosis of De Quervain Tenosynovitis involves a combination of clinical examination and patient history.
- Medical History: A thorough discussion of symptoms, occupational and recreational activities, and any prior wrist injuries or conditions.
- Physical Examination: The Finkelstein test is commonly used. This involves the patient making a fist with the thumb placed inside the fingers, then bending the wrist towards the little finger. A positive Finkelstein test is indicated by pain along the thumb side of the wrist. The doctor may also palpate the wrist in the area of the tendons to assess for swelling, tenderness, and pain.
- Imaging Tests: While not always necessary, ultrasound or MRI scans may be used to assess the extent of inflammation and rule out other conditions that may present with similar symptoms.
Non-Surgical Treatment Options
Non-surgical treatments are often the first line of approach for managing De Quervain Tenosynovitis. They aim to reduce inflammation, alleviate pain, and restore function.
Rest |
Limit activities that exacerbate the symptoms. This may involve taking a break from certain work or recreational activities. |
Splinting |
Wearing a splint or brace can help immobilise the thumb and wrist, allowing the inflamed tendons to rest and heal. |
Ice Therapy |
Applying ice to the affected area can reduce swelling and relieve pain. |
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) |
Medications such as ibuprofen or naproxen can help reduce inflammation and pain. |
Corticosteroid Injections |
Administered into the tendon sheath, these injections can reduce inflammation and pain. The number of injections is usually limited due to potential side effects. |
Physical Therapy |
Specific exercises and therapies can strengthen the wrist and thumb, improve the range of motion, and reduce symptoms. |
Surgical Treatment Options
In cases where non-surgical treatments do not provide adequate relief, surgery might be considered. This aims to reduce the pressure on the tendons and alleviate symptoms.
Tendon Sheath Release Surgery
This is the most common procedure. The surgeon makes a small incision near the base of the thumb to access the tendon sheath. The sheath is then opened to release the pressure on the tendons, allowing more room for them to move freely.
Prevention Strategies
While not all cases of De Quervain Tenosynovitis can be prevented, certain strategies can help reduce the risk of developing or exacerbating the condition.
- Ergonomic Adjustments - Using ergonomic tools and equipment, especially during repetitive tasks, can minimise the strain on the wrists and hands.
- Frequent Breaks - Taking regular breaks during activities that involve prolonged wrist movement can help reduce stress on the tendons.
- Stretching and Strengthening Exercises - Regular exercises that strengthen and stretch the muscles of the hand and wrist can improve their resilience and flexibility.
- Proper Technique - Learning and adhering to correct techniques in sports and occupational activities can prevent undue stress on the wrists.
- Managing Underlying Conditions - Effectively controlling inflammatory conditions, such as rheumatoid arthritis, can reduce the risk of tenosynovitis.
Dr Poh Seng Yew
MBBS
MRCSEd
MMED (Ortho)
FRCSEd
With over 18 years of experience, Dr Poh Seng Yew is an orthopaedic surgeon specialising in hip, knee, shoulder and elbow surgery, sports medicine, and trauma surgery.
- Former Director of Sports Service, Department of Orthopaedic Surgery, Singapore General Hospital
- Clinical Hip and Sports Medicine Fellow, Orthopädische Chirurgie München (OCM), Germany
- Fellow, Royal College of Surgeons of Edinburgh, FRCSEd (Orthopaedic Surgery)
- Master of Medicine (Orthopaedic Surgery), National University of Singapore
- Member, Royal College of Surgeons of Edinburgh (MRCSEd)
- Bachelor of Medicine, Bachelor of Surgery (MBBS), National University of Singapore
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Mount Elizabeth Novena Specialist Centre
38 Irrawaddy Road, #08-62/63
Singapore 329563
Weekdays: 9.00am – 5.00pm
Saturdays: 9.00am – 1.00pm
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Mount Elizabeth Novena Specialist Centre
38 Irrawaddy Road, #08-62/63
Singapore 329563
Frequently Asked Questions (FAQ)
What is De Quervain Tenosynovitis?
De Quervain Tenosynovitis is an inflammation of the tendons on the thumb side of the wrist, causing pain and limited movement.
What causes De Quervain Tenosynovitis?
It can be caused by repetitive motion, hormonal changes, inflammatory conditions, trauma, and other health conditions.
Can De Quervain Tenosynovitis be treated without surgery?
Yes, with rest, splinting, ice therapy, NSAIDs, corticosteroid injections, and physical therapy.
What does surgery for De Quervain Tenosynovitis involve?
It typically involves a tendon sheath release procedure to alleviate pressure on the tendons.
Are there ways to prevent De Quervain Tenosynovitis?
Preventive strategies include ergonomic adjustments, taking frequent breaks, stretching, proper technique and managing underlying conditions.