De Quervain’s Tenosynovitis

De Quervain’s ("duh-kair-VANZ") tenosynovitis, also called de Quervain’s, is a problem that makes the bottom of your thumb and the side of your wrist hurt. When you have de Quervain’s, the ropey fiber (tendon) that helps move your thumb away from your fingers becomes swollen.

People can get de Quervain’s when they injure or use the thumb or wrist too much. Some activities that might cause de Quervain’s are: 

• Wringing out wet clothes
• Hammering
• Skiing
• Knitting
• Lifting heavy objects like a jug of milk, taking a frying pan off of the stove or lifting a baby out of a crib

If you are pregnant or if you have diabetes or rheumatoid arthritis, you are more likely to get de Quervain’s. More women than men have de Quervain’s. You can get the disease at any age, though most people who have de Quervain’s are between the ages of 30 and 50.

De Quervain’s may cause pain when you twist your wrist. You might also have pain if you grab something between your thumb and fingers. Many people hear a funny sound like a squeak, crackle, snap or creak when they move the wrist or thumb.

The bottom of the thumb or the side of the wrist might also be sore or swollen. This can make it hard to move your thumb or wrist. The back of the thumb and index finger may also feel numb. Sometimes de Quervain’s can cause a small bump on the thumb side of the wrist. If you don’t get treatment, the pain can spread up your forearm or down into your thumb.

Your doctor will check for swelling, tenderness or numbness around the base of the thumb. There may also be crackling or popping when you move your thumb.

Your doctor may or may not use the Finkelstein test to help diagnose de Quervain’s. To do this test, make a fist with your thumb inside. Then bend your wrist outward toward your little finger. If you feel pain on the thumb side of your wrist, then you most likely have de Quervain’s.

The Finkelstein test is done to make sure that you do not have a different problem, such as arthritis in the bottom of your thumb or intersection syndrome. Both of these problems affect the same area of the hand and wrist as de Quervain’s.

The goal of treatment for de Quervain’s is to relieve the pain and swelling in your thumb and wrist, and restore normal function. Try the following steps to help your symptoms:

• Avoid moving the hand and wrist that hurt
• Stop the activities that caused the pain until your symptoms improve 
• Keep your wrist in a straight line with your arm by using a splint to keep your thumb and wrist from moving

You can also try to ice or heat on the area that hurts or is swollen. You can use ice for 15 minutes every four to six hours. Put a thin cloth between the ice and your skin. You can use heat for 20 to 30 minutes, two or three times a day. Try using a heating pad, hot shower or hot pack.

Ask your doctor if you can take nonsteroidal anti-inflammatory drugs (NSAIDs), including ibuprofen or naproxen. NSAIDs come in pills and in a cream that you rub over the sore area. Acetaminophen can also help with pain. Be safe with medicines. Read and follow all instructions on the label. 

Symptoms often get better in a few weeks with home care. Your doctor may want you to start some gentle stretching exercises once your symptoms are gone.

If you’ve tried the treatments above but your wrist or thumb still hurts, your doctor might give you a corticosteroid shot, also called a steroid shot. A medicine called a steroid is injected into your wrist area and the bottom of your thumb.

Within three weeks of having a steroid shot, most people can use the wrist and thumb again for normal activities. Most people feel better after just one shot, but you might need another shot after four to six weeks if your wrist and thumb still hurt. No more than three shots are used.

If your wrist and thumb do not feel better after trying home treatment and getting three shots, your doctor might talk to you about surgery. After surgery, it might take several months for your wrist to feel completely better. You may need to see a physical or occupational therapist to help you learn how to use your wrist differently. Then you can go back to your normal activities. Talk to your doctor about the side effects you may have from steroid shots or surgery for de Quervain’s.