De Quervain’s Tenosynovitis

De Quervain’s tenosynovitis is a type of tendonitis, or inflammation, of the thick, fibrous cords that connect muscle to bone. It affects the tendons on the thumb side of the wrist, causing pain, swelling and difficulty with hand movements. Symptoms are exacerbated by repetitive movements, such as texting, gripping, making a fist or twisting the wrist.

All types of tendonitis are typically caused by repetitive motions, overuse of a muscle group (such as from playing a sport), arthritis and trauma to the affected area. De Quervain’s tenosynovitis results from inflammation of the tendons on the thumb side of the wrist and typically results from repetitive movements of the thumb and wrist, such as gripping, holding or lifting objects.

Certain sports or occupations requiring repetitive thumb and wrist movements can cause De Quervain’s tenosynovitis. Poor technique and form during hobbies such as racket sports, knitting or gardening can also lead to this condition, resulting in additional strain on the surrounding tendons.

To prevent De Quervain’s tenosynovitis, it’s essential to use proper form when performing repetitive motions with this muscle group and take regular breaks. Additionally, stretching the joints and muscles in the hand before and after activities is a good idea. Many also find relief by using a splint or brace to support the tendons in the hand.

De Quervain’s tenosynovitis affects the tendons on the thumb side of the wrist, causing pain, swelling and difficulty with hand movements. Repetitive movements, such as texting, gripping, making a fist or twisting the wrist, exacerbate symptoms. Individuals with De Quervain’s tenosynovitis may experience one or more of the following symptoms:

• Catching or snapping sensation
• Difficulty pinching or grasping the hand
• Numbness or tingling in the thumb that may extend into the forefinger
• Pain at the base of the thumb that radiates up the forearm
• Swelling on the thumb side of the wrist
• Tenderness in the thumb and/or wrist
• Weakness of the grip

Like tendonitis, De Quervain’s tenosynovitis is typically diagnosed through a physical examination and a medical history review. The experts at the Montefiore Einstein Department of Physical Medicine and Rehabilitation may diagnose your condition using ultrasound, X-ray or magnetic resonance imaging (MRI) to look for signs of inflammation.

During the physical exam, your provider will look for signs of pain and tenderness when the muscle attached to the tendon is moved in certain ways. There are specific tests for each tendon that will help your provider target the specific tendons affected by De Quervain’s tenosynovitis.

The goal of treatment is to relieve pain and reduce inflammation in the muscles and tendons in the hand. Your provider will recommend resting and avoiding activities that irritate the affected tendon to help it recover, which may be done using a splint or a removable brace. Applying heat or cold to the affected area can help.

Over-the-counter pain relievers, such as non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin or ibuprofen, can also reduce pain and inflammation, and steroid injections into the tendon sheath can be beneficial for controlling pain. Your provider may also suggest physical therapy to stretch and strengthen the muscle and tendon. This can restore the tendon’s ability to function properly, improve healing and prevent future injury. In rare cases, surgery is needed to remove the inflamed tissue from around the tendon.

The team of specialists at the Department of Physical Medicine and Rehabilitation may also address De Quervain’s tenosynovitis and its symptoms with the following treatment plans: 

• Home exercises
• Activity modification, if necessary
• Use of a splint or brace to immobilize the wrist and thumb
• Treatment with anti-inflammatory medication, as needed
• Local corticosteroid injections, as needed
• Non-opioid-based pain management 

De Quervain’s tenosynovitis symptoms typically improve with treatment and rest. If the injury is caused by overuse, a change in work habits or hobbies may be needed to prevent the problem from returning.

Complications of De Quervain’s tenosynovitis may include long-term inflammation, which raises the risk of further injury and a return of symptoms if not adequately treated.