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What is De Quervain’s?

De Quervains tenosynovitis (ten-oh-sin-oh-VY-tis) is an inflammation of tissue on the thumb side of the wrist.  Tendons (cordlike fibers that attach muscle to bone) and synovium (a slick membrane that allows the tendons to move easily) become irritated, causing pain.

Causes

Making the same motions over and over, such as repeatedly unscrewing jar lids, grasping a tool, or picking up a child under the arms, can irritate the tendons.  So can an injury to the thumb side of the wrist.

Symptoms

The most common symptom is pain on the thumb side of the wrist.  You may feel pain when you pinch or grasp thinks, turn or twist your wrist, or make a fist.  The thumb may also “catch” when you bend it.  The thumb side of the wrist may be tender to the touch, any you may feel a small “knot”.

Your doctor can usually tell by moving your thumb whether the tendons are inflamed.  Treatment will depend on how severe the pain is.

Evaluating Your Thumb

To diagnose de Quervain’s, your doctor may ask you to make a fist with your fingers over your thumb.  He or she will then gently bend your wrist toward your little finger.  A sharp pain in the wrist is a sign that the tendons are inflamed.

Nonsurgical Treatment

Just taking a break from the activities that caused your pain may be enough.  Your doctor may also have you take oral anti-inflammatory medication, such as aspirin, or wear a splint for a few weeks to rest the thumb and wrist.  To reduce the swelling, your doctor may inject an anti-inflammatory, such as cortisone, around the tendons.  You may have more pain at first, but in a few days your thumb should feel better.

Surgery

If other kinds of treatment don’t relieve your pain, or if the pain is severe, your doctor may recommend surgery.  The sheath that surrounds the tendons is released so the tendons can move more easily.  This helps reduce the inflammation, and allows you to straighten your thumb without pain.  Usually, surgery takes a few minutes and is done with local anesthetic, so you can go home the same day.  You will probably have a splint or dressing on our wrist for a few days while the tissue heals.  Your doctor will discuss the risks and possible complications of surgery with you.

Inside Your Thumb

Tendons connect muscles in your wrists and forearm to the bones in your thumb.  The tendons are surrounded by a protective tendon sheath.  This sheath is lined with synovium, which produces a fluid that allows the tendons to slide easily when you straighten your thumb.  If the tendons are irritated or injured, they become inflated.

When the Tendons Are Inflamed

When the tendons are inflamed, they cause the lining of the tendon sheath to swell and thicken.  Or the tendon sheath itself may thicken.  Then the sheath pinches the tendons.  They can no longer slide easily inside the sheath, and straightening your thumb and wrist may become painful.

Using Your Thumb Again

The goal of your treatment is to relieve your pain and allow you to use your thumb again.  Once the tendons have healed, your doctor may give you exercises, or refer you to a therapist, to help you regain strength and movement in your thumb.  Following your doctor’s directions will help you get back to your normal activities.