A 45 year old woman loved working in her garden daily, and spent all afternoons digging the soil, planting, weeding, pruning, and watering the plants. After some time she developed pain at the base of her thumb when she was trying to use her garden tools. She neglected it and continued to work. Gradually the pain increased, and it became difficult for her to even move her thumb. She consulted her family doctor who diagnosed the condition to be de Quervain’s Tenosynovitis. This condition is named after it’s discoverer, the Swiss surgeon, Dr. Fritz de Quervain in the year 1895 AD.
About de Quervain’s Tenosynovitis
When the tendons of the wrist on the thumb side get inflamed (swelling) there is pain and discomfort on turning the wrist or trying to grab something. This condition is known as de Quervain’s Tenosynovitis. The swelling of the membranes covering the tendon ( fibrous connective tissue which connects muscle to bone) become inflamed exerting pressure on the nerves in the vicinity, leading to numbness and severe pain in the area.
The risk factors that can lead to de Quervain’s Tenosynovitis are hobbies involving repetitive wrist movements like gardening, carpentry or playing musical instruments. It can also be seen in pregnancy where there are hormonal changes and in women who are between 30 years to 50 years of age. People having arthritis are at high risk of developing this condition. Parents who often rock their child are also seen to be affected by this condition.
The person with de Quervain’s Tenosynovitis may develop pain and swelling at the base of the thumb that may increase gradually or appear suddenly. This pain may spread from the thumb into the forearm. A cyst filled with fluid may develop in the area of the swelling. When doing activities like knitting, playing music or working in the garden, the pain intensifies and there may be difficulty in moving the thumb. There could be a squeaking sound when the person tries to move his or her thumb, due to movement of tendons.
Causes
When a person repeatedly over uses his wrist for performing tasks for example, like wringing a cloth every day, this will cause pain and swelling of the tendons leading to de Quervain’s Tenosynovitis. This condition can also occur because of rheumatoid arthritis and direct injury to the tendon. In the case of injury, scar tissue is formed in the area which restricts the movement of the tendons causing pain and swelling in the area.
Diagnosis
A test known as Finkelstein test is done to confirm de Quervain’s Tenosynovitis. In this test, the person is made to bend his or her thumb across the palm, and then the other fingers are made to bend over the thumb after which the wrist is made to bend towards the little finger. If pain is arising on the side of wrist and thumb due to these movements, then the Finkelstein test is positive for de Quervain’s Tenosynovitis.
Treatment
To reduce the swelling and pain, the thumb and wrist are splinted for 4 to 6 weeks, 24 hours a day so that they get complete rest. Application of ice or heat on the affected area may reduce the swelling. Pain killers like Non steroidal anti inflammatory drugs (Ibuprofen or Naproxene) may be prescribed by the doctor for pain relief. The doctor may also inject corticosteroid injections or local anesthetics into the tendon to reduce the swelling. An occupational therapist or physical therapist will help the affected person by showing him or her various exercises that will help in making the muscles strong. In severe cases, surgery is recommended. If treatment is not taken, then there is a tendency that there will be permanent limitation in the movements of the wrist, and there is also a chance of bursting of the tendon sheath.
Prevention
To prevent de Quervain’s Tenosynovitis, one must avoid repetitive actions involving the wrist and thumb. Breaks in between activties involving thumb and wrist movement is necessary to give ample rest to them. A splint or brace can be worn to give rest to the thumb and wrist. Exercises suggested by the physical therapist have to be done regularly.
