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Mathias Masem, M.D.
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Shoulder | Elbow | Wrist | Hand

De Quervain's Tendonitis

What is deQuervain's tendonitis?

First dorsal compartment tendonitis, more commonly known as de Quervain’s tendonitis or tenosynovitis after the Swiss surgeon Fritz de Quervain, is a condition brought on by irritation or inflammation of the wrist tendons at the base of the thumb (see Figure 1, 1A).

Figure 1: The first dorsal compartment. There are six compartments on the dorsal, or back, side of the wrist. The first and third compartments house tendons which control the thumb.

The inflammation causes the compartment (a tunnel or a sheath) around the tendon to swell and enlarge, making thumb and wrist movement painful. Making a fist, grasping or holding objects are common painful movements with this condition.

What causes deQuervain's tendonitis?

The cause of de Quervain’s tendonitis is an irritation of the tendons at the base of the thumb, usually caused by taking up a new, repetitive activity. New mothers are especially prone to this type of tendonitis: caring for an infant often creates awkward hand positioning, and hormonal fluctuations associated with pregnancy and nursing further contribute to its occurrence. A wrist fracture can also predispose a patient to de Quervain’s tendonitis, because of increased stresses across the tendons.

Signs and symptoms of deQuervain's tendonitis

Figure 1A: De Quervain’s Tendonitis

Pain over the thumb-side of the wrist is the main symptom. The pain may appear either gradually or suddenly, and pain is located at the first dorsal compartment (Figure 1A) at the wrist. Pain may radiate down the thumb or up the forearm. Hand and thumb motion with forceful grasping or twisting increases pain. Swelling over the base of the thumb may include a fluid-filled cyst in this region. There may be an occasional “catching” or “snapping” when moving the thumb. Because of the pain and swelling, motion such as pinching may be difficult. Irritation of the nerve lying on top of the tendon sheath may cause numbness on the back of the thumb and index finger.



Diagnosis of deQuervain's tendonitis

Tenderness directly over the tendons on the thumb-side of the wrist is the most common finding. A test is generally performed in which the patient makes a fist with the fingers clasped over the thumb.

Figure 2 and 3

The wrist is then bent in the direction of the little finger (Figure 2 and 3). This maneuver can be quite painful for the person with de Quervain’s tendonitis.

Treatment of deQuervain's tendonitis

The goal is to relieve the pain caused by the irritation and swelling. Your doctor may recommend resting the thumb and wrist by wearing a splint. Oral anti-inflammatory medication may be recommended. A cortisone-type of steroid may be injected into the tendon compartment as another treatment option. Each of these non-operative treatments help reduce the swelling, which typically relieves pain over time. In some cases, simply stopping the aggravating activities may allow the symptoms to go away on their own.

When symptoms are severe or do not improve, surgery may be recommended. The surgery opens the compartment to make more room for the inflamed tendons, which breaks the vicious cycle where the tight space causes more inflammation. Normal use of the hand can usually be resumed once comfort and strength have returned.

What can you do to help?
  • Avoid wrist positions and activities which are painful.
  • Ice for five to fifteen minutes at a time on the area which is most swollen and tender.
  • “Over the counter” non-steroidal anti-inflammatory medication (NSAID), such as aspirin, ibuprofen, or naprosyn. Check with your pharmacist regarding possible side effects and drug interactions.
  • A splint or brace which supports both the wrist and the thumb. A wrist support splint which doesn't support the thumb is not as effective.
What can a therapist do to help?
  • Provide a variety of hand splints to support the thumb and the wrist.
  • Help identify aggravating activities and suggest alternative postures.
  • Massage, heat, ice and other treatments aimed at making the area more comfortable.
What can a doctor do to help?
  • Confirm that this actually is the problem.
  • Prescribe stronger NSAID medication or cortisone-type medication.
  • Prescribe hand therapy and/or a custom prescription splint.
  • Give a cortisone shot into the area of the most irritation.
  • Perform surgery to enlarge the tight channel so that the tendons no longer chafe.
How successful is treatment?
  • Many people with mild symptoms will improve with a limited period of anti-inflammatory medication and avoiding painful activities, especially if the problem developed during unaccustomed strenuous activities. It is less likely to resolve if it is related to light repetitive work activities.
  • A cortisone shot into the sore area helps most people - at least temporarily. When temporary, relief usually lasts about two months. One or two shots provide permanent relief for as many as two out of three people with this problem.
  • Surgery helps over four out of five people with this problem, but as many as one out of five will have a new problem after surgery, such as numbness on the back of the hand or tenderness of the scar.
What happens if you have no treatment?

It depends on how much it is bothering you - it really is a quality of life issue. This is not a problem which can spread to other parts of your body or which must be treated within a limited period of time. Some people will have a mild problem that flares up from time to time and they treat it or ignore it. Others will have a severe problem that prevents them from doing many things with their hand. At that point, surgery becomes an option.