De Quervain's Tenosynovitis
What is de Quervain's tenosynovitis?
De Quervain's (say "duh-kair-VANZ") tenosynovitis, also called De Quervain's, is a problem that makes the bottom of your thumb and the side of your wrist hurt. When you have de Quervain's, the ropey fiber (tendon) that helps move your thumb away from your fingers becomes swollen. See a picture of de Quervain's.
What causes de Quervain's?
People can get de Quervain's when they hurt or use the thumb or wrist too much. Common activities that need your wrist and thumb can cause the problem. Some activities that might cause de Quervain's are:
- Wringing out wet clothes.
- Lifting heavy objects such as a jug of milk, taking a frying pan off of the stove, or lifting a baby out of a crib.
If you are pregnant or if you have diabetes or rheumatoid arthritis, you are more likely to get de Quervain's. More women than men have de Quervain's. You can get the disease at any age. Most people who have de Quervain's are women between the ages of 30 and 50.
What are the symptoms?
De Quervain's may cause pain when you twist your wrist. You might also have pain if you grab something between your thumb and fingers. Many people hear a funny sound like a squeak, crackle, snap, or creak when they move the wrist or thumb.
The bottom of the thumb or the side of the wrist might also be sore or swollen. This can make it hard to move your thumb or wrist. The back of the thumb and index finger may also feel numb. Sometimes de Quervain's can cause a small bump on the thumb side of the wrist. If you don't get treatment, the pain can spread up your forearm or down into your thumb.
How is de Quervain's diagnosed?
Your doctor will check for swelling, tenderness, or numbness around the base of the thumb. There may also be crackling or popping when you move your thumb.
Your doctor may or may not use the Finkelstein test to help diagnose de Quervain's. To do this test, make a fist with your thumb inside. Then bend your wrist outward toward your little finger. If you feel pain on the thumb side of your wrist, then you most likely have de Quervain's.
The Finkelstein test is done to make sure that you do not have a different problem, such as arthritis in the bottom of your thumb or intersection syndrome. Both of these problems affect the same area of the hand and wrist as de Quervain's.
How is it treated?
The goal of treatment for de Quervain's is to relieve the pain and swelling in your thumb and wrist, and restore normal function. Try the following steps to help your symptoms:
- Avoid moving the hand and wrist that hurt.
- Until your symptoms are better, stop the activities that caused the pain.
- Keep your wrist in a straight line with your arm by using a splint to keep your thumb and wrist from moving.
- Try ice or heat on the area that hurts or is swollen. You can use ice for 15 minutes every 4 to 6 hours. Put a thin cloth between the ice and your skin. You can use heat for 20 to 30 minutes, 2 or 3 times a day. Try using a heating pad, hot shower, or hot pack.
Ask your doctor if you can take nonsteroidal anti-inflammatory drugs (NSAIDs), including ibuprofen (such as Advil) or naproxen (such as Aleve). NSAIDs come in pills and in a cream that you rub over the sore area. Acetaminophen (such as Tylenol) can also help with pain. Be safe with medicines. Read and follow all instructions on the label.
Symptoms often get better in a few weeks with home care. Your doctor may want you to start some gentle stretching exercises once your symptoms are gone.
But if your wrist or thumb still hurts, your doctor might give you a corticosteroid shot, also called a steroid shot. A medicine called steroid is injected into your wrist area and the bottom of your thumb.
Within 3 weeks of having a steroid shot, most people can use the wrist and thumb again for normal activities. Few good studies have been done, but in one small study everyone who had a corticosteroid injection had no symptoms 6 days later. People who were using a splint still had some symptoms after 6 days.footnote 1 Most people feel better after just one shot, but you might need another shot after 4 to 6 weeks if your wrist and thumb still hurt. No more than 3 shots are used.
If your wrist and thumb do not feel better after trying home treatment and getting 3 shots, your doctor might talk to you about surgery. After surgery it might take several months for your wrist to feel completely better. You may need to see a physical or occupational therapist to help you learn how to use your wrist differently. Then you can go back to your normal activities. Talk to your doctor about the side effects you may have from steroid shots or surgery for de Quervain's.
- Peters-Veluthamaningal C, et al. (2009). Corticosteroid injection for de Quervain's tenosynovitis. Cochrane Database of Systematic Reviews (3).
Other Works Consulted
- American Academy of Orthopaedic Surgeons and American Academy of Pediatrics (2010). De Quervain tenosynovitis. In JF Sarwark, ed., Essentials of Musculoskeletal Care, 4th ed., pp. 443–444. Rosemont, IL: American Academy of Orthopaedic Surgeons.
- Bednar MS, et al. (2014). Hand surgery. In HR Skinner, PJ McMahon, eds., Current Diagnosis and Treatment in Orthopedics, 5th ed., pp. 456–516. New York: McGraw-Hill.
- O'Neill CJ (2015). De Quervain tenosynovitis. In WR Frontera et al., eds., Essentials of Physical Medicine and Rehabilitation, 3rd ed., pp. 136–139. Philadelphia: Saunders.
- Swigart CR (2013). Hand and wrist pain. In GS Firestein et al., eds., Kelley's Textbook of Rheumatology, 9th ed., vol. 1, pp. 708–720. Philadelphia: Saunders.
Current as of: November 16, 2020
Author: Healthwise Staff
William H. Blahd Jr. MD, FACEP - Emergency Medicine
Adam Husney MD - Family Medicine
E. Gregory Thompson MD - Internal Medicine
Kathleen Romito MD - Family Medicine
Herbert von Schroeder MD, MSc, FRCSC - Hand and Microvascular Surgery
Current as of: November 16, 2020
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