De Quervain’s Tenosynovitis

Diagnosis and Treatment

Dr. Pamela Mehta, MD

What is De Quervain’s Tenosynovitis?

De Quervain’s tenosynovitis is a common painful wrist condition caused by irritation of the tendons in the side of your wrist joint. It often occurs without a clear cause, though factors such as age and sex can put you at a higher risk of developing it. It can be treated with simple measures such as a splint, but sometimes requires hand surgery.

Sometimes known as de Quervain’s tendonitis, this condition affects two tendons which pass through a tendon sheath (fibrous covering) in your wrist at the base of your thumb. To protect your tendon from rubbing against the sheath, they are covered by a slippery soft-tissue layer called the synovium. When this becomes swollen and inflamed, it causes pain at the side of your wrist and difficulty with wrist movements.

The cause of de Quervain’s tenosynovitis is often unclear, though it is sometimes associated with overuse and repetitive wrist movements such as from gardening, gaming, or playing tennis.

You are at higher risk of de Quervain’s tenosynovitis if you are:

Aged 30-50, though those in other age groups can still develop de Quervain’s tenosynovitis
Female – women are up to 10 times more likely to develop it
Recovering from, or previously had, a wrist injury
Pregnant, or have just given birth
Suffering from rheumatoid arthritis

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Do I Have De Quervain’s Tenosynovitis?

If you have pain or swelling in your wrist and thumb, you might have de Quervain’s tenosynovitis. Pain can come on suddenly or gradually over time. It is felt at the base of your thumb and outside of your wrist – where the inflamed tendons are found.

Symptoms of de Quervain’s tenosynovitis include:

Pain at the base of your thumb and outer wrist
Pain traveling up your forearm or into your thumb
Swelling near the base of your thumb
Numbness in your thumb and index finger
A squeaking sound or catching sensation when moving your thumb

How is De Quervain’s Tenosynovitis Diagnosed?

When you see Dr. Mehta, she will examine your wrist and thumb, locating the site of discomfort and checking if certain movements cause pain. She will determine possible causes of pain and decide whether you need any further tests.

Usually, joint pain requires an x-ray to help rule out alternative diagnosis. However, if you have no concerning symptoms and all of the classic signs of de Quervain’s tenosynovitis are present, this may not be necessary.

De Quervain’s Tenosynovitis vs Carpal Tunnel Syndrome

Carpal tunnel syndrome also causes pain in your wrist, but unlike de Quervain’s tenosynovitis, carpal tunnel syndrome tends to cause pain and numbness in your palm, thumb, and first two fingers, rather than your wrist and base of your thumb.

An orthopedic specialist, such as Dr. Pamela Mehta, can differentiate between the two conditions by carefully assessing your symptoms and evaluating your wrist.

How is De Quervain’s Tenosynovitis Treated?

Simple measures to help with the pain and swelling include:

Resting your thumb
Avoiding painful movements
Taking anti-inflammatory medications
Placing an ice pack on your wrist
Gently massaging your wrist

Splints, Braces, and Physical Therapy for De Quervain's Tenosynovitis

Resting your thumb and wrist might be difficult, especially if you have pain in your dominant hand. A splint or brace designed for de Quervain’s tenosynovitis makes it easy to immobilize both your wrist and thumb. Splints can often be bought from a pharmacy, though it’s important that you get a splint that fits well.

Sometimes special exercises can help you recover from de Quervain’s tenosynovitis, though it is important that this is supervised by a physical therapist to avoid making your condition worse. Dr. Mehta can advise you on whether stretching or de Quervain’s tenosynovitis exercises will help or harm your symptoms.

Cortisone Injection For De Quervain's Tenosynovitis

Normally, symptoms improve after 4-6 weeks with treatment. If your symptoms are more severe, or aren’t improving with a brace or splint, Dr. Mehta might recommend a cortisone injection. Cortisone, a type of steroid, is injected into the tendon sheath which is irritated, reducing inflammation and swelling. This relieves the pain in over half of cases.

Surgery For De Quervain's Tenosynovitis

If your symptoms continue, you may require hand surgery. This is known as de Quervain’s tenosynovitis release or decompression and opens the tendon sheath in your wrist to make room for the irritated tendons. This can generally be done under a local anesthetic.

Recovery from surgery is usually quick, with pain from your irritated tendons subsiding within the first few days. Physical therapy is often used to help in your recovery from surgery. You will have a small scar on your wrist which might remain sore for a few weeks after the operation.

Testimonials

“Dr. Mehta is a wonderful Orthopedic Surgeon. I had severe Carpal Tunnel Syndrome in both hands and wrists. The pain was so terrible and the numbness that I bought 3 different types of wrists splints to help reduce discomfort that I was experiencing especially at night--the pain and numbness was keeping me up at night. I finally decided to go to see Dr Mehta, an Orthopedic Surgeon, whom a personal friend suggested that I see, and I took her up on it and I am glad that I did. Thank You Dr. Mehta for all the care you showed me. I would recommend you to all of my friends and to anyone who needed an Orthopedic Surgeon. You take time out to explain things to your patients and you show your patients a lot of compassion. Thank You for all the care you showed me--Thank you again!”

“I went to see Dr. Pamela Mehta for arthritis hand pain in both my thumbs. She gave me the options of PRP or cortisone injections. I decided to have the cortisone injections, my insurance would cover the costs. Of course there was some minor pain from the injections, but the next day my pain was almost completely gone! I could not hold a heavy book before the treatment but now I can! I highly recommend Dr. Mehta, awesome people skills and very competent.”

Dr. Pamela Mehta, MD – Orthopedic Surgeon in San Jose, California

Dr. Pamela Mehta is an orthopedic surgeon and a specialist in all aspects of orthopedic care. She can rule out alternate diagnoses and make sure you get the best possible treatment plan for a swift recovery. Dr. Mehta offers her services as a hand surgeon to treat hand conditions such as de Quervain’s tenosynovitis.

Resilience Orthopedics is based in San Jose, California. To make sure you get the right diagnosis and treatment the first time, get in touch to begin your journey to recovery.

Further Information

Hand Pain

Learn about the causes of hand and wrist pain, what the diagnosis could be, and the treatments available.

Hand Surgery

Learn about hand and wrist surgery, including minimally invasive surgical techniques.

Hand Conditions

Learn about different hand and wrist conditions, their symptoms, how they are diagnosed, and what treatment we can offer at Resilience Orthopedics, including: