DEQUERVAIN'S TENDINITIS

What is it?

deQuervain’s tendinitis is a condition of friction and inflammation affecting the tendons of two thumb muscles, caused by a tight, restrictive tube of collagenous tissue. This friction and irritation lead to pain and tenderness along the thumb side of the wrist, typically noticed when gripping with the thumb or pinching small objects. Occasionally it produces a sharp, shooting pain when the thumb is stretched away from the palm or when force is applied to the thumb during activities.

What causes it?

The cause of deQuervain’s tendinitis is thought to be mechanical overload of the tube with increased thumb use or loading. For example, awkward hand positions required by a new mother in caring for an infant is a common cause of this condition. Other examples are working the weekend in the garden, or moving house.

Signs and symptoms.

Pain over the thumb side of the wrist is the main symptom. The pain may appear either gradually or suddenly. It is felt in the wrist and can travel up the forearm. The pain is usually worse with use of the hand and thumb, especially when forcefully grasping things. Swelling over the thumb side of the wrist is noticed and may be accompanied by a small cyst. There may be an occasional “catching” or “snapping” when moving the thumb. Because of the pain and swelling, it may be difficult to move the thumb and wrist, such as in pinching. Irritation of the nerve lying on top of the tendon sheath may cause numbness on the back of the thumb and index finger.

Diagnosis.

A Finkelstein test is usually very painful. In this test, the patient makes a fist with the fingers over the thumb. The wrist is then bent in the direction of the little finger causing pain. Tenderness directly over the tendons on the thumb-side of the wrist is also found.

Treatment.

The goal is to reduce the inflammation and easing of tightness around the affected tendon. Usually a steroid injection is used, and this treatment can relieve symptoms and resolve the problem in about 80% of cases.

When symptoms are severe or fail to improve with conservative treatments, surgery may be recommended. The procedure involves opening the carpal tunnel to create more space for the inflamed or irritated tendons and relieve pressure on the median nerve. Most patients can gradually return to normal hand use once pain has subsided and strength has recovered, typically over a period of about 1 to 3 weeks.