De Quervain’s tenosynovitis

De Quervain’s tenosynovitis is a painful condition affecting the tendons on the thumb side of the wrist. There is a sheath that covers these tendons and tenosynovitis is irritation and inflammation of this sheath.

How does it occur?

Often the cause of the pain is unknown.

Overusing the tendon with repetitive movements of the thumb can make the pain and swelling worse. It may also be brought on by a simple strain. It is common in mothers on young children.

What are the symptoms?

Symptoms may include:

1. Pain with activities such as pinching, grasping or wringing
2. Pain with lifting
3. Swelling and tenderness around the base of the thumb

How is it diagnosed?

An examination by a doctor or a physiotherapist will determine the area that is tender and painful to move. The Finklestein test is a simple way of diagnosing De Quervain’s.

You start by placing the thumb in the palm of your hand towards your little finger. Make a fist around your thumb and then flex the wrist downwards towards your little finger. The test is positive if it is painful.

How is it treated?

• Avoid activities that are painful as much as you can.
• Ice therapy – place an ice pack on your thumb and wrist for 20 minutes every 3-4 hours. Do not put ice directly next to the skin as it may cause an ice burn.
• Wearing a thumb spica splint may help. These splints can be obtained from a pharmacy or online. The splint must immobilise the thumb as well as strapping around the wrist.
• Anti-inflammatory medication may be helpful. You will need to speak to you GP or pharmacist for further advice.
• Physiotherapy exercises can help to restore the movement and strengthen the muscles around the thumb.
• In cases that do not improve a steroid injection may be considered.
• Surgical decompression of the tendon tunnel will be considered if all other treatment has not helped.