De Quervain's tenosynovitis
De Quervain's tenosynovitisArticle Sections
DefinitionDe Quervain's tenosynovitis (duh-kare-VAHS ten-oh-sine-oh-VIE-tis) is a painful inflammation of the tendons on the thumb side of your wrist. If you have de Quervain's tenosynovitis, you're likely to feel discomfort every time you turn your wrist, grasp anything or make a fist. Although the cause of de Quervain's tenosynovitis isn't known, any activity that relies on repetitive hand or wrist movement — such as working in the garden, playing music, knitting, cooking, lifting your baby or walking your pet — can aggravate the condition. Treatment for de Quervain's tenosynovitis may range from immobilizing your wrist and taking medications to surgery in more serious cases. If you start treatment early on, your symptoms of de Quervain's tenosynovitis should generally improve within four to six weeks. SymptomsThe main signs and symptoms of de Quervain's tenosynovitis are pain and swelling near the base of your thumb. The pain may appear suddenly or may increase over time. If the condition goes too long without treatment, the pain may spread farther into your thumb, back into your forearm or both. Pinching, grasping and other movements of your thumb and wrist aggravate the pain. Symptoms of de Quervain's tenosynovitis include:
When to see a doctor
If the pain continues to interfere in your daily life or activities, seek medical advice. CausesWhen you grip, grasp, clench, pinch or wring anything in your hand, you use two major tendons in your wrist and lower thumb. These tendons run side by side from your forearm through the thumb side of your wrist. They normally glide unhampered through the small tunnel that connects them to the base of the thumb. In de Quervain's tenosynovitis, the tendons' slippery covering becomes inflamed, restricting movement of the tendons. Chronic overuse of your wrist is commonly associated with de Quervain's tenosynovitis. For example, wringing out a cloth involves a repetitive motion, a bent wrist and the gripping of the cloth. If you repeat an action like this day after day, this combination may be enough to irritate the sheath around the two tendons. Other causes of de Quervain's tenosynovitis include:
Risk factorsPeople most often diagnosed with de Quervain's tenosynovitis tend to be those whose occupations or hobbies involve repetitive hand and wrist motions, such as carpenters, office workers and musicians. Even the awkward hand and wrist positions that new parents use in holding and rocking their children may aggravate the condition. Other risk factors for de Quervain's tenosynovitis include being:
ComplicationsYou may begin to limit your hand and wrist movements to avoid pain from untreated de Quervain's tenosynovitis. Lack of movement leads to more pain and less strength and flexibility in your hand. Eventually, your range of motion may be severely restricted. Preparing for your appointmentMake an appointment with your doctor if you have hand- or wrist-related pain and self-care measures — such as avoiding activities that trigger your pain — aren't helping. After an initial exam, your doctor may refer you to an orthopedist, rheumatologist, hand therapist or occupational therapist. Here's some information to help you get ready for your appointment, and what to expect from your doctor. What you can do
Below are some basic questions to ask a doctor who evaluates you for wrist- or hand-related symptoms. If any additional questions occur to you during your visit, don't hesitate to ask.
What to expect from your doctor
What you can do in the meantime Tests and diagnosisTo diagnose de Quervain's tenosynovitis, your doctor likely will confirm that you have both:
In a Finkelstein test, you bend your thumb across the palm of your hand and bend your fingers down over your thumb. Then you bend your wrist toward your little finger. If this causes pain on the thumb side of your wrist, the test is considered positive. Finkelstein testYour doctor may confirm a diagnosis of de Quervain's tenosynovitis by doing a Finkelstein test. If the motions in the Finkelstein test cause pain, the test is considered positive. ...  Treatments and drugsTo reduce pain and swelling, initial treatment of de Quervain's tenosynovitis may include:
Your doctor may also recommend injections of corticosteroid medications into the tendon sheath to reduce swelling. Treatment is generally successful if begun early on, though the pain may recur if you continue the repetitive motions that aggravate your condition.
Making adjustments
In more serious cases Lifestyle and home remediesIf you don't need surgery, caring for your condition is much the same as preventing it:
If you do need surgery, it may be several months before the tenderness in your wrist completely goes away. Your doctor will talk to you about how to rest, strengthen and rehabilitate your body after surgery. A physical or occupational therapist may meet with you after surgery to teach you new strengthening exercises and help you adjust your daily routine to prevent a recurrence of the condition. PreventionSince the underlying cause of de Quervain's tenosynovitis isn't known, there's no clear way to prevent the condition. Still, if you have wrist pain that's aggravated by repetitive wrist and hand movements, it may help to avoid actions such as:
RelatedLast Updated: 2010-04-03 © 1998-2013 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved. A single copy of these materials may be reprinted for noncommercial personal use only. "Mayo," "Mayo Clinic," "MayoClinic.com," "Mayo Clinic Health Information," "Reliable information for a healthier life" and the triple-shield Mayo logo are trademarks of Mayo Foundation for Medical Education and Research.
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