De Quervain's Tenosynovitis

De Quervain's tenosynovitis involves inflammation of one or two tendon linings (sheaths) or strain of one or two tendons to the thumb: extensor pollicis brevis (EPB), or abductor pollicis longus (APL). This causes pain on the side of the wrist and base of the thumb. Tendon sheaths secrete a fluid that lubricates the tendon, allowing the tendon to move smoothly. When the sheath becomes inflamed, the tendon cannot move freely in the sheath. Both the EPB and APL tendons are important for proper use of the hand. The EPB tendon is important for straightening the thumb. The APL tendon is important for moving the thumb away from the index finger (abducting). The two tendons pass through a small tube (canal) in the wrist, near the base of the thumb. When the tendons become inflamed, pain is usually felt in this area.

SYMPTOMS

  • Pain, tenderness, swelling, warmth, or redness over the base of the thumb and thumb side of the wrist.

  • Pain that gets worse when straightening the thumb.

  • Pain that gets worse when moving the thumb away from the index finger, against resistance.

  • Pain with pinching or gripping.

  • Locking or catching of the thumb.

  • Limited motion of the thumb.

  • Crackling sound (crepitation) when the tendon or thumb is moved or touched.

  • Fluid-filled cyst in the area of the base of the thumb.

CAUSES

  • Tenosynovitis is often linked with overuse of the wrist.

  • Tenosynovitis may be caused by repeated injury to the thumb muscle and tendon units, and with repeated motions of the hand and wrist, due to friction of the tendon within the lining (sheath).

  • Tenosynovitis may also be due to a sudden increase in activity or change in activity.

RISK INCREASES WITH:

  • Sports that involve repeated hand and wrist motions (golf, bowling, tennis, squash, racquetball).

  • Heavy labor.

  • Poor physical wrist strength and flexibility.

  • Failure to warm up properly before practice or play.

  • Female gender.

  • New mothers who hold their baby's head for long periods or lift infants with thumbs in the infant's armpit (axilla).

PREVENTION

  • Warm up and stretch properly before practice or competition.

  • Allow enough time for rest and recovery between practices and competition.

  • Maintain appropriate conditioning:

  • Cardiovascular fitness.

  • Forearm, wrist, and hand flexibility.

  • Muscle strength and endurance.

  • Use proper exercise technique.

PROGNOSIS

This condition is usually curable within 6 weeks, if treated properly with non-surgical treatment and resting of the affected area.

RELATED COMPLICATIONS

  • Longer healing time if not properly treated or if not given enough time to heal.

  • Chronic inflammation, causing recurring symptoms of tenosynovitis. Permanent pain or restriction of movement.

  • Risks of surgery: infection, bleeding, injury to nerves (numbness of the thumb), continued pain, incomplete release of the tendon sheath, recurring symptoms, cutting of the tendons, tendons sliding out of position, weakness of the thumb, thumb stiffness.

TREATMENT

First, treatment involves the use of medicine and ice, to reduce pain and inflammation. Patients are encouraged to stop or modify activities that aggravate the injury. Stretching and strengthening exercises may be advised. Exercises may be completed at home or with a therapist. You may be fitted with a brace or splint, to limit motion and allow the injury to heal. Your caregiver may also choose to give you a corticosteroid injection, to reduce the pain and inflammation. If non-surgical treatment is not successful, surgery may be needed. Most tenosynovitis surgeries are done as outpatient procedures (you go home the same day). Surgery may involve local, regional (whole arm), or general anesthesia.

MEDICATION

  • If pain medicine is needed, nonsteroidal anti-inflammatory medicines (aspirin and ibuprofen), or other minor pain relievers (acetaminophen), are often advised.

  • Do not take pain medicine for 7 days before surgery.

  • Prescription pain relievers are often prescribed only after surgery. Use only as directed and only as much as you need.

  • Corticosteroid injections may be given if your caregiver thinks they are needed. There is a limited number of times these injections may be given.

COLD THERAPY

  • Cold treatment (icing) should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain, and immediately after activity that aggravates your symptoms. Use ice packs or an ice massage.

SEEK MEDICAL CARE IF:

  • Symptoms get worse or do not improve in 2 to 4 weeks, despite treatment.

  • You experience pain, numbness, or coldness in the hand.

  • Blue, gray, or dark color appears in the fingernails.

  • Any of the following occur after surgery: increased pain, swelling, redness, drainage of fluids, bleeding in the affected area, or signs of infection.

  • New, unexplained symptoms develop. (Drugs used in treatment may produce side effects.)