De Quervains Tenosynovitis

What is it?

This is a painful condition affecting the tendons in your wrist, specifically two at the base of the thumb. These tendons are responsible for moving the thumb out and away from the palm of the hand.

Why does it occur?

The cause is unknown, but is thought to be secondary to thickening and swelling of the retinaculum encasing the tendons and not an inflammatory process. There is known to be a preponderance in women and ages 30-50, most commonly developing in the dominant wrist. De Quervain’s tenosynovitis is also associated with certain risk factors involving ‘overuse’ activities such as racquet sports and golf.  The condition may also develop secondary to trauma.

What are the symptoms?

Pain and swelling felt at the base of the thumb are the most common symptoms. This will be aggravated by certain thumb movements involving the affected tendons.

How is it diagnosed?

Your clinician will usually be able to establish whether you are suffering from tenosynovitis after taking a history and examining the affected wrist. Further investigations are not normally needed but in some cases X-rays may be organised to rule out other causes.

How is it treated?

1.    Non-surgical treatment

The majority of cases resolve with rest, ice and anti-inflammatory medication. A thumb spica splint is often used to straighten and immobilise the thumb but steroid injections may be considered as an alternative option in those where it hasn’t helped. 

2.    Surgical treatment

This may be considered in the small number of patients with severe symptoms who haven’t responded to over 6 months of conservative treatment. It involves the surgical release of the retinaculum or sheath surrounding the affected tendons at the base of the thumb. This reduces pressure and enables the tendons to glide freely thereby reducing pain.