The extensor pollicis brevis and abductor pollicis longus pass through a tight channel, called the first dorsal compartment, which joins the forearm to the thumb. The tendons are encased by sheaths, or a covering, that run through the first dorsal compartment. The sheaths are lined with synovial fluid (synovium) so the tendons can slide easily through them.
De Quervain’s tenosynovitis is the thickening of the sheaths that encase these tendons. This occurs when the tendon sheaths and synovium become irritated and inflamed. When the sheath swells the tendons have difficulties passing through. The swelling may also put pressure on the radial nerve or other nerves in the wrist resulting in pain and/or numbness.
De Quervain’s syndrome is caused by repetitive overuse or hyperextension of the tendons. Frequent twisting, grasping, clenching, pinching or wringing can irritate the synovium and sheath causing swelling and inflammation.
Mothers with infants and day care workers who frequently lift babies are most commonly affected by de Quervain’s tenosynovitis. However, it may also be triggered by a direct blow to the area around the radial styloid process.
Due to the cause of de Quervain’s tenosynovitis, it is also referred to as mommy thumb and mother’s wrist, as well as, de Quervain’s disease, radial styloid tenosynovitis, de Quervain’s syndrome or washerwoman’s sprain.
- Pain at the base of the thumb that increases when twisting the wrist or grabbing an object
- Swelling over the thumb side of the wrist – a fluid filled cyst may form in the area
- Moving the wrist and/or thumb, grasping, or pinching is difficult
- A catching sensation when you move your thumb may also occur but is not always present
- Numbness on the thumb and back of the index finger caused the irritation of the radial nerve
- Squeaking as the tendon tries to move through the sheath
If you are experiencing wrist pain, acommon test used to diagnose if it is de Quervain’s tenosynovitis is the Finkelstein Test. The doctor will ask you to make a fist around the thumb of your sore wrist and turn your wrist so the thumb in on top. With your wrist relaxed, the doctor will push down on your fist, bending the wrist down. If pain is felt along the side of the wrist and base of the thumb it is a positive indicator of de Quervain’s syndrome.
Surgery is not usually necessary, and is typically the option of last resort. Treating de Quervain’s syndrome with home therapies such as cold compression, and Blood Flow Stimulation Therapy™can reduce the inflammation and swelling allowing for smooth movementof your tendons once again. If surgery is required, use of these therapies following the procedure will provide optimal healing of the tendon tissue and surrounding area. This will improve your range of motion in the thumb and reduce the risk of the condition returning.
A troublesome complication of surgery for de Quervains tenosynovitis is a painful neuroma of the radial nerve as well as increased presence of scar tissue due to the invasive nature of surgery.
To reduce the chance surgery will be require, it is important to treat de Quervain’s tenosynovitis as soon as possible, as any activity or strain you put on your thumb can re-injure it further. Though the pain, discomfort, and inconvenience of de Quervain’s syndrome can be overwhelming, it is possible to overcome it.
Treating Your Wrist Tendon
The trick with any tendon injury is getting it to heal with minimal scar tissue formation and with as much realignment of the tendon fibres as possible. Even with optimum healing, there is always less elasticity in a previously injured tendon. This will cause the tendon to hurt, during everyday activities. If you heal your injury efficiently and quickly, your chance of re-injury later on is much lower than average.
Allowing your tendon to rest is always recommended following injury. Try to avoid grasping, wringing, twisting and pinching or any other activities that may have caused the injury or irritation and begin cold compression treatments as soon as possible. The tendons in the thumbs and fingers are difficult to rest completely as they are essential for daily chores and activities.