Anatomy
De Quervain’s tendinosis occurs when the tendons around the base of the thumb are irritated or constricted. The word “tendinosis” refers to a swelling of the tendons. Swelling of the tendons, and the tendon sheath, can cause pain and tenderness along the thumb side of the wrist. This is particularly noticeable when forming a fist, grasping or gripping something, or when turning the wrist
Two of the main tendons to the thumb pass through a tunnel (or series of pulleys) located on the thumb side of the wrist. Tendons are rope-like structures that attach muscle to bone. Tendons are covered by a slippery thin soft-tissue layer, called synovium. This layer allows the tendons to slide easily through a fibrous tunnel called a sheath.
Any swelling of the tendons and/or thickening of the sheath, results in increased friction and pain with certain thumb and wrist movements.
Causes
- De Quervain’s tendinosis may be caused by overuse. It also is associated with pregnancy and rheumatoid disease. It is most common in middle-aged women
Symptoms
- Pain may be felt over the thumb side of the wrist. This is the main symptom. The pain may appear either gradually or suddenly. Pain is felt in the wrist and can travel up the forearm. The pain is usually worse when the hand and thumb are in use. This is especially true when forcefully grasping objects or twisting the wrist.
- Swelling may be seen over the thumb side of the wrist. This swelling may accompany a fluid-filled cyst in this region.
- A “catching” or “snapping” sensation may be felt when moving the thumb.
- Pain and swelling may make it difficult to move the thumb and wrist.
Treatments
- Splints may be used to rest the thumb and wrist.
- Anti-inflammatory medication (NSAIDs). These medications can be taken by mouth or injected into a tendon compartment. This may help reduce swelling and relieve pain.
- Avoiding activities that cause pain and swelling. This may allow the symptoms to go away on their own.
- Injection of corticosteroids into the tendon sheath may help reduce swelling and pain
