De Quervain's Tenosynovitis

  • Medical Author:
    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

  • Medical Editor: John P. Cunha, DO, FACOEP
    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

Symptoms of Rheumatoid Arthritis

What is de Quervain's tenosynovitis?

De Quervain's tenosynovitis is inflammation of tendons on the side of the wrist at the base of the thumb. These tendons include the extensor pollicis brevis and the abductor pollicis longus tendons, which extend the joints of the thumb.

What are causes and risk factors of de Quervain's tenosynovitis?

De Quervain's tenosynovitis can be brought on by simple strain injury to the extensor pollicis longus and abductor pollicis tendons (tendinitis). Often this form of tendinitis is a result of repetitive motion injury. Typical causes of de Quervain's tenosynovitis include stresses such as lifting young children into car seats, lifting heavy grocery bags by the loops, and lifting gardening pots up and into place.

Risk factors for de Quervain's tenosynovitis include the following:

  • Being female
  • Age over 40
  • African ethnicity/descent
  • Pregnancy

What are signs and symptoms of de Quervain's tenosynovitis?

De Quervain's tenosynovitis causes symptoms of pain and tenderness at the side of the wrist beneath the base of the thumb. Sometimes there is slight swelling and redness in the area.

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De Quervain's Tenosynovitis Treatment

Cortisone Injection

Cortisone injections can be used to treat the inflammation of small areas of the body (local injections), or they can be used to treat inflammation that is widespread throughout the body (systemic injections). Examples of conditions for which local cortisone injections are used include inflammation of a bursa (bursitis of the hip, knee, elbow, or shoulder), a tendon (tendinitis such as tennis elbow), and a joint (arthritis). Knee osteoarthritis, hip bursitis, painful foot conditions such as plantar fasciitis, rotator cuff tendinitis, frozen shoulder, and many other conditions may be treated with cortisone injections. Certain skin disorders, such as alopecia (a specific type of hair loss), can be treated with cortisone injections.

What tests do physicians use to diagnose de Quervain's tenosynovitis?

De Quervain's tenosynovitis is diagnosed based on the typical appearance, location of pain, and tenderness of the affected wrist. De Quervain's tenosynovitis is usually associated with pain when the thumb is folded across the palm and the fingers are flexed over the thumb as the hand is flexed down toward the little finger away from the involved wrist area. (This is referred to as the Finkelstein maneuver.) X-rays and other imaging tests are usually not needed to diagnose de Quervain's tenosynovitis.

What specialties of doctors treat de Quervain's tenosynovitis?

De Quervain's tenosynovitis is commonly diagnosed and treated by primary-care physicians (PCPs) including general practitioners, family medicine physicians, and internists. Specialists who treat de Quervain's tenosynovitis include orthopedic surgeons, sports-medicine doctors, and rheumatologists. Occupational therapists and physical therapists can be involved in the care of patients with de Quervain's tenosynovitis.

What is the treatment for de Quervain's tenosynovitis?

Treatments for de Quervain's tenosynovitis includes any combination of rest, splinting, ice, anti-inflammation medication, and/or cortisone injection. Cortisone injection is extremely effective and is generally the optimal treatment. Normal activity may be resumed within three weeks after an injection. Surgery to release the tendon sheath is only rarely necessary and usually reserved for persisting inflammation after failure of at least one cortisone injection.

Are there home remedies for de Quervain's tenosynovitis?

De Quervain's tenosynovitis can initially be treated with home remedies, including cold packs, resting, and over-the-counter medications, such as ibuprofen (Motrin, Advil) and naproxen (Aleve). Care must be taken to avoid reinjuring the strained tendon at the wrist. For example, young mothers must be very careful about lifting their children without straining the involved side of the wrist.

What is the prognosis with de Quervain's tenosynovitis?

The prognosis for de Quervain's tenosynovitis is excellent. The patient can generally return to full function after the inflammation quiets down with treatment. Sometimes bracing is used during future activities that involve repetitive wrist motion.

Is it possible to prevent de Quervain's tenosynovitis?

De Quervain's tenosynovitis can be prevented by avoiding activities that stress the wrist and avoiding repetitive motion injuries.

REFERENCES:

Firestein, Gary S., et al. Kelley's Textbook of Rheumatology, 9th Edition. Philadelphia, PA: Saunders, 2013.

Wolf, J.M., and R.X. Sturdivant, and B.D. Owens. "Incidence of de Quervain's Tenosynovitis in a Young, Active Population." J Hand Surg Am 34.1 Jan. 2009: 112-115.

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Reviewed on 8/10/2016
References
REFERENCES:

Firestein, Gary S., et al. Kelley's Textbook of Rheumatology, 9th Edition. Philadelphia, PA: Saunders, 2013.

Wolf, J.M., and R.X. Sturdivant, and B.D. Owens. "Incidence of de Quervain's Tenosynovitis in a Young, Active Population." J Hand Surg Am 34.1 Jan. 2009: 112-115.

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