Introduction
De Quervain’s Tendonitis is a condition characterized by inflammation of the tendons on the thumb side of the wrist. Tendons are the connective tissues that attach muscles to bones, and they can become swollen and painful due to overuse. Historically, this condition was known as “Washer Woman’s Syndrome” because the repetitive motions involved in wringing wet clothes—such as thumb pinching, squeezing, and outward wrist movements—can lead to the development of De Quervain’s Tendonitis.
Anatomy
De Quervain's Tendonitis involves two specific tendons that facilitate thumb movement. These tendons pass through a structure known as the tendon sheath, connecting two forearm muscles to the wrist: the Extensor Pollicis Brevis and the Abductor Pollicis Longus. These muscles allow the thumb to extend and move away from the hand, enabling actions like pinching, grasping, and squeezing. They also assist in lateral movements, such as waving.
Causes
The exact causes of De Quervain’s Tendonitis remain unclear. However, it may arise from irritation of the tendons at the base of the thumb. Repetitive thumb movements and wrist deviation—bending the wrist to the side—can irritate the tendons as they navigate through the tendon sheath. Common activities that may contribute to this condition include wringing laundry, gardening, and the awkward movements associated with lifting and caring for infants.
Overuse can lead to tendon swelling and fluid accumulation, resulting in Tendonitis. Additionally, the lining of the tendon sheath can become inflamed, a condition referred to as Tenosynovitis. These conditions can occur independently or simultaneously. Tissue swelling linked to metabolic disorders like diabetes and rheumatoid arthritis may also trigger De Quervain’s Tendonitis, which often surfaces during pregnancy or menopause when fluid retention is more likely. Direct trauma to the wrist or sudden strain from unfamiliar exercises can also contribute to the onset of this condition.
Symptoms
The primary symptom of De Quervain’s Tendonitis is pain located at the thumb side of the wrist, which may also radiate to the forearm. This pain can develop either suddenly or gradually, often intensifying during thumb and wrist movements that involve grasping or pinching. If the nerve atop the tendon sheath becomes irritated, you might experience numbness in the back of your thumb and index finger.
Additionally, swelling may occur in the wrist and thumb area, and some individuals might develop a fluid-filled cyst in this region. You may also hear crackling sounds or feel a catching sensation when moving your thumb, and some may find it difficult to move their thumb and wrist freely.
Diagnosis
A physician can diagnose De Quervain’s Tendonitis through a physical examination of your wrist and hand, along with a review of your symptoms and activities. One common diagnostic tool is the Finkelstein test. In this test, your doctor will ask you to make a fist with your thumb tucked inside and then bend your wrist toward the little finger side. A positive result is indicated by pain at the base of the thumb.
Treatment
For many individuals, simply avoiding activities that provoke discomfort can lead to symptom relief. Others may respond well to treatments aimed at alleviating pain and facilitating rest. Doctors often recommend using a splint to support the affected joints. Anti-inflammatory medications can help reduce pain and swelling, and in some cases, a cortisone injection may be administered into the tendon sheath.
Surgery
Surgery is generally considered when symptoms persist despite conservative treatment options. This outpatient procedure may involve sedation or numbing the area with local or regional anesthesia. During surgery, the surgeon will create an incision in the wrist to access the tendon sheath and may remove swollen tissue to enlarge the space for the inflamed tendons.
In some instances, working with an occupational therapist can help individuals gradually regain strength and movement while managing discomfort and swelling.
Recovery
Recovery from De Quervain’s Tendonitis varies from person to person, depending on the treatment approach and the severity of the condition. Your doctor can provide guidance on what to expect during the recovery process. Most people experience favorable outcomes and can fully recover from this condition.
