De Quervain's tenosynovitis Iohere whakawaikura a de Quervain
De Quervain's tenosynovitis is a painful wrist condition affecting the 2 tendons that control your thumb. The tendons are on the back of your hand and run down the back of your thumb and the side of your wrist.
Causes of de Quervain's tenosynovitis
The cause is uncertain but repetitive actions with the hand are known to make it worse. Once you have the condition, physical activities at work, in the garden and in sport can make it worse.
De Quervain's tenosynovitis can happen after you have injured the back of your wrist, but there may be no obvious cause.
You are most likely to get de Quervain's tenosynovitis if you are between 30 and 50 years. It is more common in women than in men.
Women in late pregnancy or with a young pēpi are more likely to get it. Hormones may play a part, but it could also be related to the repeated wrist actions of lifting your pēpi.
Symptoms of de Quervain's tenosynovitis
In de Quervain's tenosynovitis, the 2 thumb tendons get inflamed and swollen within their tendon sheaths (like tunnels the tendons move through). This means they do not slide smoothly when your thumb moves.
This causes pain at the base of your thumb, especially when doing things like:
- giving a thumbs-up sign
- using scissors
- grasping and pinching
- text messaging.
You can get swelling at the base of your thumb. It may be tender to touch, or hard and lumpy.
You might have symptoms in both wrists or just one. It often affects the hand you use most — your right hand if you are right-handed.
Diagnosing de Quervain's tenosynovitis
Your healthcare provider or physiotherapist will diagnose the condition after talking to you and examining your hand. You will probably not need any other tests.
An x-ray is only useful if your healthcare provider thinks something else might be causing your pain.
Self care for de Quervain's tenosynovitis
- Rest your hand and thumb as much as possible for 4 to 6 weeks. This should reduce the inflammation, which may solve the problem. Try this first — it works for most people.
- Avoid any repetitive or heavy activities using your thumb and hand, such as gardening, some manual work, DIY and carrying your pēpi.
- Ask someone else to do the activities that really hurt.
- If your other hand is pain free, use it more often.
- Try wearing a splint (a thumb spica splint) that stops your thumb and wrist from moving — it helps you to rest your tendons.
- The splint keeps your thumb slightly bent, in its natural, relaxed position but allows your wrist to work properly. You do not need to wear one all the time — try wearing it at night and during any activity that makes the pain worse. You can buy thumb splints in pharmacies, sports shops or from a hand therapist.
- Trying new ways of doing things can make a big difference. Lift your pēpi by scooping them up under their bottom instead of lifting them from under their arms. Keep your palms facing up and use your forearms to take the weight.
- If they are safe for you to use, take paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen for pain. If you are not sure whether you can take these, ask your healthcare provider or pharmacist.
Treating de Quervain's tenosynovitis
If resting for 4 to 6 weeks does not work, your healthcare provider may be able to give you a steroid injection. Injecting steroids into the tendon sheath in your hand reduces the inflammation. You might need a second injection if the first does not help.
Your healthcare provider may give you the injection or refer you to another provider or specialist for this treatment.
Steroid injections are very effective, so it is unlikely you will need surgery for de Quervain's tenosynovitis. But if you have had 2 steroid injections and still have wrist and thumb pain, you may need surgery. Your healthcare provider can refer you to a plastic surgeon or orthopaedic surgeon.
Steroid injections — Healthinfo (external link)
Surgery
Surgery aims to release the tendon sheath so the tendon can glide more easily. It is done under a local anaesthetic injection that numbs the area while you are still awake.