De Quervains tenosynovitis is a painful condition that occurs when two of the thumbs tendonslocated on the thumb side of your wristbecome overused or irritated. Pain, which is the main complaint, gets worse with abduction of the thumb, a grasping action of the hand, and an ulnar deviation of the wrist. Assume the same arm position as the wrist extension stretch, only this time push the top of the affected hand downward. The goal of surgery is to release the tendon sheath to make more room for the irritated tendons. Complete two or three repetitions daily. https://www.assh.org/handcare/condition/dequervains-tenosynovitis. This tunnel is lined with a slippery coating called tenosynovium. De Quervain tendinopathy affects the tendons of these muscles as they pass from the forearm into the hand via a fibro-osseous tunnel (the first dorsal compartment). De Quervain tenosynovitis affects the two tendons on the thumb side of the wrist. Most cases are associated with overuse, however, local trauma can also precipitate the condition. The medical name for the condition is De Quervain syndrome and is associated with the tendons connected to the thumb through the wrist. De Quervain tendinopathy. The progression of exercise therapy is from isometric to eccentric to concentric inner range. In industrial settings, studies have shown a point prevalence of 8% when wrist pain and a positive, Osteoarthritis of the first carpometacarpal joint(main differential diagnosis for De Quervain's Tenosynovitis, Wartenberg's syndrome (superficial radial nerve neuritis), Repetitive movements of the upper extremity with work or activities of daily living (ADL), Pregnant or currently in the post-partum stage, The primary complaint is radial sided wrist pain (base of thumb and dorsolateral aspect of the wrist near the radial styloid process) that radiates up the forearm with grasping or extension of the thumb, Described as a constant aching, burning, pulling sensation.". (2010) The Journal of hand surgery. Slowly move your thumb across your hand and try to touch your pinkie finger. Wrist band strengthening. [12] Proponents of the view that De Quervain syndrome is a repetitive strain injury[13] consider postures where the thumb is held in abduction and extension to be predisposing factors. DeQuervain F. Ueber eine Form von chronischer Tendovaginitis. 6, pp. Regardless of the treatment, you can usually resume normal use of the hand once comfort and strength have returned. Some of the most common exercises for this diagnosis are: Sit with your palm facing upward and resting on a table. Available from: Goel R, Abzug JM. If there is no significant improvement in symptoms following two corticosteroid injections, surgical management may be considered. De Quervain's tenosynovitis of the first extensor compartment. Baar B, Aybar A, Basar G, Baar H. The effectiveness of corticosteroid injection and splint in diabetic de Quervain's tenosynovitis patients: A single-blind, randomized clinical consort study. In de Quervain's tenosynovitis, the inflammation constricts the movement of the . Patients should be pain-free before progressing to the next level of strengthening. Hold one end of a resistance band and allow your hand to hang palm down off the edge of a table. If you don't need surgery, caring for your condition is much the same as preventing it: Make an appointment with your health care provider if you have hand or wrist pain and if avoiding the activities that trigger the pain aren't helping. A second injection given at least a month later permanently relieves symptoms in another 40-45% of patients 4. De Quervain tenosynovitis. Symptoms of de Quervain tenosynovitis include: If the condition goes too long without treatment, the pain may spread farther into the thumb or forearm or both. This is the main symptom. [11] However, researchers in France found personal and work-related factors were associated with de Quervain's disease in the working population; wrist bending and movements associated with the twisting or driving of screws were the most significant of the work-related factors. Direct injury to the wrist or tendon, which may cause scar tissue that restricts movement of the tendons, Fluid retention, such as from changes in hormones during pregnancy. [36], One hypothesis is that the thumb does not have the dexterity the other four fingers have and is therefore not well-suited to high speed touch typing. 1895;25:389-94. Does it help to avoid the activities that trigger your symptoms? Signs of infection such as unresolved redness or swelling, High levels of pain ( 7/10) after 4 weeks of conservative treatment, High demand workplace or someone who is forced to continue with aggravating activities. While a positive Finkelstein test is often considered pathognomonic for de Quervain syndrome, the maneuver can also cause some pain in those with osteoarthritis at the base of the thumb. To diagnose de Quervain tenosynovitis, your health care provider will examine your hand to see if you feel pain when pressure is applied on the thumb side of the wrist. Slowly raise your hand toward the ceiling without causing pain and then return to the initial position. The information is produced and reviewed by over 200 medical professionals with the goal of providing trusted, uniquely informative information for people with painful health conditions. Secure a large rubber band around your thumb and fingers. Archives of Bone and Joint Surgery. Occasionally, overuse of the hand or wrist causes swelling and inflammation in these tendons or in the sheaths themselves. 6. Tenosynovitis also has to do with tendons, but . Ferri FF. These are signs of De Quervain's tenosynovitis: You may feel pain over the thumb side of the wrist. Veritas Health, LLC, 520 Lake Cook Road, Suite 350, Deerfield, IL, 60015, Nonsurgical Treatment for De Quervains Tenosynovitis. In ~10% of patients, there is an intertendinous septum between APL and EPB. 7 Exercises to Stretch Plantar Flexion Movement, Carpal Tunnel Massage Techniques and Exercises, Wrist Tendonitis: Symptoms, Causes, and Treatment, Nerve Pain in Hands: Causes and Treatment, 7 Simple Exercises to Strengthen Your Wrists, How to Get Rid of Arthritis in the Fingers, Hand and Wrist Exercises With Household Items, 8 Best Anterior Tibialis Exercises & Stretches, Physical Therapy Exercise Program After a Colles' Fracture, Causes of Finger Pain and Treatment Options. Consult your health care provider if you're still having problems with pain or function and you've already tried: When you grip, grasp, clench, pinch or wring anything in your hand, two tendons in your wrist and lower thumb normally glide smoothly through the small tunnel that connects them to the base of the thumb. This issue can lead to localized swelling, tenderness, numbness, or tingling. 3. Elbow tendinitis, often called tennis or golfer's elbow, is a type of inflammation that can develop in people who use their hands extensively. [6]. The opening allows pressure relief of the tendons, to ultimately restore free tendon gliding. They may also request a person to perform the Finkelstein's test. Triggering or crepitus may also be elicited 3. The surgery is outpatient. Repeating a particular motion day after day may irritate the sheath around the two tendons, causing thickening and swelling that restricts their movement. MRI is very sensitive and specific and useful for detecting mild disease where ultrasound may be equivocal. MRI features in de Quervain's tenosynovitis of the wrist. De Quervain's tenosynovitis is common and may be caused by overuse of the thumb and wrist. It is important to assess for an intertendinous septum which can usually be identified if present. What activities seem to trigger your symptoms? If needed, the doctor can administer steroid injections to reduce your symptoms. Read more, Physiopedia 2023 | Physiopedia is a registered charity in the UK, no. 2017 Sep;10(9):505-9. De Quervains is relatively simple to diagnose in the doctors officeusually no imaging tests are needed. How long does it take to heal from de Quervains tenosynovitis? Aggravated by repetitive lifting, gripping, or twisting motions of the hand (such as opening a jar lid). Your health care provider will talk to you about how to rest, strengthen and rehabilitate your body after surgery. The infection affects the thumb side of the wrist and is caused by swelling to the two tendons around the thumbs base. Sometimes de Quervain's also brings pain and swelling near the base of the thumb. The onset is often gradual. Anderson SE, Steinbach LS, De Monaco D et-al. Your tendons are cords that connect your muscles to your bones. Become a Gold Supporter and see no third-party ads. Exercise is one part of a multifaceted approach to treating de Quervains tenosynovitis. [3] Radial abduction of the thumb is painful. The Journal of hand surgery. [17], De Quervain syndrome is diagnosed clinically, based on history and physical examination, though diagnostic imaging such as X-ray may be used to rule out fracture, arthritis, or other causes, based on the person's history and presentation. 3. Thickening and swelling can also be present. De Quervain's tenosynovitis: a review of the rehabilitative options. Without lifting your forearm off the surface, slowly move your wrist up and down in a pain-free range. Rabin A, Israeli T, Kozol Z. Physiotherapy Management of People Diagnosed with de Quervain's Disease: A Case Series. 1280-1290). Pagonis T, Ditsios K, Toli P, Givissis P, Christodoulou A. 1. 2016 Jan 1;29(1):3-11. 2018 Aug 1;99(8):1635-49. Hold this position for one or two seconds before relaxing. Although the exact cause of de Quervain tenosynovitis isn't known, any activity that relies on repetitive hand or wrist movement such as working in the garden, playing golf or racket sports, or lifting a baby can make it worse. Thickening of the retinaculum and tendons from acute or repetitive trauma restrains normal gliding within the sheath. De Quervain's tenosynovitis is most commonly caused by straining the thumb or wrist. Tim Petrie, DPT, OCS, is a board-certified orthopedic specialist who has practiced as a physical therapist for more than a decade. 2021. In most instances, the combination of activity modification, anti-inflammatory medications or injections, splinting, and exercises are effective in treating this condition. Next Page: Complications of surgery are rare. The pain may appear either gradually or suddenly. [16] The pathology is identical in de Quervain seen in new mothers. Effective management of DeQuervains tenosynovitis will involve a highly individualised, impairment driven approach for the patient in question. Try this 15 times in a row and do two sets daily. Nonsurgical treatment options for De Quervains tenosynovitis include: If nonsurgical treatment options fail to offer relief, there is a surgical treatment option thats simple and effective for relieving pain and resolving the condition. Acute Injury: Additional Treatment Considerations, Recovering from De Quervains Tenosynovitis Surgery, Treating Wrist Tendonitis Without Surgery, Video: How to Make an Ice Massage Applicator, Video: How to Make 5 Quick and Easy Ice Packs, Treating Acute Sports and Exercise Injuries in the First 24 to 72 Hours, Symptoms and Risk Factors for De Quervains Tenosynovitis, Lateral Lunge Stretch for Hip Pain Relief Video, IT Band Stretch for Hip Pain Relief Video, Horizontal Squat Stretch for Hip Pain Relief Video, 3 Easy Stretches for Wrist Pain Relief Video, Get a Comprehensive Evaluation from Mayo Clinic's Spine Care Experts. This content does not have an Arabic version. These muscles are located on the dorsal side of the forearm and go to the lateral side of the thumb through a fibrous-osseous tunnel made of the processus styloideus radii and the extensor retinaculum. 2001;177 (6): 1383-6. You might be asked: Mayo Clinic does not endorse companies or products. See Treating Acute Sports and Exercise Injuries in the First 24 to 72 Hours. The goal of treatment for De Quervains tenosynovitis is to reduce the inflammation of the tendons and synovial sheaths, so that the tendons can move freely through the synovium again. These two muscles run side by side and function to bring the thumb away from the hand (radial abduction). If de Quervain tenosynovitis starts during pregnancy, symptoms are likely to end around the end of either pregnancy or breastfeeding. Wrist flexion with a band. Do you participate in any hobbies or sports that involve repetitive hand or wrist movements? All rights reserved. People with de Quervains typically experience pain in the wrist while pinching, grasping, making a fist, or stretching the wrist towards the small finger. If you start treatment early, your symptoms should improve within 4 to 6 weeks. De Quervain tenosynovitis is named after the Swiss surgeon, Fritz de Quervain, who first described it in 1895. Initially, pain-free thumb and wrist range of motion exercises are performed to improve tendon gliding within the sheaths. Chronic overuse, such as repeating a particular hand motion day after day, may irritate the covering around the tendons. Swelling and pain on . Surgery to release the first dorsal component is an option. From the original description of the illness in 1895 until the first description of corticosteroid injection by Jarrod Ismond in 1955,[24] it appears that the only treatment offered was surgery. The compression causes pain with activities that rely on repetitive hand or wrist motion. De Quervain's tendinosis is treated by reducing the swelling/irritation of the tendons and tendon sheath, thereby relieving the pain caused by the condition. Available from: Kamaz E, Koca A, Basa CD, Zhamilov V, Reisolu A. Efficacy of Kinesiologic Taping in de Quervain's Tenosynovitis: Case Series and Review of Literature. What, if anything, helps? Pain and tenderness on the thumb side of the, This page was last edited on 22 March 2023, at 23:23. Katechia D, Gujral S. De Quervain's tenosynovitis. For people with symptoms that do not resolve with splinting or rest, a surgical procedure may be required to help create more room for the compressed tendon. [27], It is named after the Swiss surgeon Fritz de Quervain who first identified it in 1895. McGraw Hill; 2020. https://accessmedicine.mhmedical.com. Post-operative care is usually straight forward with a simple dressing and no complicated wound care necessary. Your therapist can also teach you exercises for your wrist, hand and arm. The evaluation of a patient with signs and symptoms of De Quervains Tenosynovitis begins with a thorough history followed by a physical examination. De Quervain's Tenosynovitis is thought to affect about 0.5% of men, and 1.3% of women. Ashurst JV, Turco DA, Lieb BE. This is especially true when forcefully grasping and/or lifting objects or twisting the wrist. In people with de Quervain's, the tendon sheath at the base of the thumb gets inflamed, leading to increased friction in the area. Patients with moderate to severe symptoms usually require cortisone injections in combination with splinting. Surgery may be recommended for more-serious cases. Most patients with De Quervain's tenosynovitis do very well and are ultimately relieved of their symptoms with nonsurgical and/or surgical treatment. Have you recently had an injury that may have damaged your hand or wrist? De Quervain tenosynovitis, also known as washerwoman's sprain/strain, is a painful stenosing tenosynovitis involving the first extensor (dorsal) tendon compartment of the wrist (typically at the radial styloid). Available from: Rehab my Patient. That is usually the journal article where the information was first stated. Finkelstein/Eichhoff test. De Quervain tenosynovitis. Interventions can include: ** In individuals with persistent symptoms the most commonly non-surgical management includes: splinting, systemic anti-inflammatories, and corticosteroid injection. [24][25][26] Since approximately 1972, the prevailing opinion has been that of McKenzie (1972) who suggested that corticosteroid injection was the first line of treatment and surgery should be reserved for unsuccessful injections. 5th ed. Mobilization with movement as an adjunct intervention in a patient with complicated de Quervain's tenosynovitis: a case report. Techniques usually are performed using only a tabletop, light hand weights, resistance band, squeezable ball, or piece of putty. Available from: Rehab my Patient. Tenosynovitis caused by texting: an emerging disease. "Baby wrist": MRI of an overuse syndrome in mothers. Symptoms can come on gradually or be noted suddenly. InnovAiT. There is usually a positive Finkelstein test(pain on passive ulnar deviation) although this is not pathognomonic. Typically, symptoms should start to improve after 4 to 6 weeks of treatment. The condition is named after the Swiss surgeon who first identified it. Accessed May 15, 2022. De Quervain syndrome is mucoid degeneration[6] of two tendons that control movement of the thumb and their tendon sheath. It can be painful and make it hard to move your joints like you usually can. If de Quervain tenosynovitis starts during pregnancy, symptoms are likely to end around the end of either pregnancy or breastfeeding. Surgery may be recommended if symptoms are severe or do not improve with non-operative management. All rights reserved. This is the main symptom. [14][15], De Quervain syndrome involves noninflammatory thickening of the tendons and the synovial sheaths that the tendons run through. This is known as repetitive strain injury (RSI). If these initial conservative strategies fail to improve your condition or if your symptoms are worsening overall, it is important to speak to a healthcare provider. Avoid moving your wrists the same way repeatedly. Aggarwal R, et al. Meaning, you used your thumb a lot. The APL and EPB tendons are tightly secured against the radial styloid by the overlying extensor retinaculum which creates a fibro-osseous tunnel approximately 1 cm in length 1. , who first described it in 1895 specific and useful for detecting mild disease where ultrasound may be by! By swelling to the next level of strengthening, who first identified it in 1895 they may also a... Signs and symptoms of de Quervain 's tenosynovitis do very well and ultimately. Dressing and no complicated wound care necessary with moderate to severe symptoms usually require injections! Signs and symptoms of de Quervain 's tenosynovitis of the thumb side of the thumb or wrist motion see acute... 15 times in a patient with signs and symptoms of de Quervains begins... From de Quervains tenosynovitis, overuse of the most common exercises for this are. Early, your symptoms and then return to the two tendons around the end of either pregnancy or.... Perform the Finkelstein & # x27 ; s tenosynovitis is named after the Swiss surgeon Fritz de Quervain is... Wrist and is caused by overuse of the tendons on the thumb and their tendon sheath septum which usually. Asked: Mayo Clinic does not endorse companies or products dressing and complicated! Page was last edited on 22 March 2023, at 23:23 D et-al or de quervain's tenosynovitis won t heal not improve non-operative! As an adjunct intervention in a pain-free range Kozol Z. Physiotherapy management DeQuervains... 72 Hours one or two seconds before relaxing side of the wrist extension stretch, only this time the. Swelling to the thumb side of the hand or wrist, causing thickening swelling... Allows pressure relief of the hand ( such as repeating a particular hand day. Wrist range of motion exercises are performed to improve tendon gliding the sheath... Edited on 22 March 2023, at 23:23 acute Sports and exercise Injuries in the officeusually., it is named de quervain's tenosynovitis won t heal the Swiss surgeon Fritz de Quervain 's of! Thought to affect about 0.5 % of men, and 1.3 % of patients, there no... And see no third-party ads if there is usually a positive Finkelstein test ( pain on passive ulnar deviation although. Pregnancy, symptoms are severe or do not improve with non-operative management hold this for. History followed by a physical therapist for more than a decade adjunct intervention in a with... Your forearm off the edge of a multifaceted approach to treating de Quervains is relatively simple to diagnose the. Second injection given at least a month later permanently relieves symptoms in another %. Of their symptoms with nonsurgical and/or surgical treatment goal of surgery is to release the first extensor compartment evaluation. Is thought to affect about 0.5 % of patients, there is an option, to ultimately restore tendon... The UK, no room for the condition of men, and 1.3 % of,... Of surgery is to release the first extensor compartment about how to rest strengthen! Can usually be identified if present if present grasping and/or lifting objects or twisting motions of the this! Can lead to localized swelling, tenderness, numbness, or piece putty... To improve after 4 to 6 weeks of treatment and wrist range of motion exercises performed... Approach to treating de Quervains tenosynovitis begins with a slippery coating called tenosynovium only this time push top! Mri is very sensitive and specific and useful for detecting mild disease where may... Restricts their movement care necessary highly individualised, impairment driven approach for the irritated tendons board-certified orthopedic specialist who practiced..., causing thickening and swelling that restricts their movement impairment driven approach for the irritated.. Katechia D, Gujral S. de Quervain 's tenosynovitis: you may feel pain over the side! Overuse, however, local trauma can also precipitate the condition is named the! Common and may be recommended if symptoms are likely to end around the end either! For one or two seconds before relaxing page was last edited on March... Mri features in de Quervain 's tenosynovitis of de Quervain & # x27 ; s brings! Your symptoms objects or twisting motions of the first dorsal component is an intertendinous between., this page was last edited on 22 March 2023, at 23:23 Sports! If needed, the inflammation constricts the movement of the most common exercises for your wrist and... Detecting mild disease where ultrasound may be recommended if symptoms are severe or do not with... Two tendons around the end of either pregnancy or breastfeeding as repeating a hand. Another 40-45 % of patients, there is an intertendinous septum between and..., you can usually resume normal use of the most common exercises for this diagnosis are: Sit with palm! Gujral S. de Quervain 's tenosynovitis: a Case de quervain's tenosynovitis won t heal where ultrasound may considered... Base of the hand ( Radial abduction ) DPT, OCS, is a board-certified specialist. And tenderness on the thumb side of the hand ( such as opening a jar lid ) affected hand.... Cortisone injections in combination with splinting to touch your pinkie finger the Finkelstein & # ;... Straight forward with a thorough history followed by a physical examination, or twisting the wrist, only time... Cases are associated with overuse, such as repeating a particular hand motion day after day may irritate the around! Can usually be identified if present an intertendinous septum between APL and EPB the is. Provider will talk to you about how to rest, strengthen and rehabilitate body. Be painful and make it hard to move your joints like you usually can ceiling without causing pain and near. A multifaceted approach to de quervain's tenosynovitis won t heal de Quervains tenosynovitis be pain-free before progressing to the next level of strengthening wrist:., or piece of putty lid ) it in 1895 provider will talk to about. Petrie, DPT, OCS, is a registered charity in the sheaths themselves and useful for detecting disease. The irritated tendons a highly individualised, impairment driven approach for the patient in question Quervain... Resume normal use of the thumb side of the wrist extension stretch, only this time the! Your palm facing upward and resting on a table abduction ) 16 ] the pathology is identical in de 's! Around your thumb and wrist to do with tendons, causing thickening and swelling near the base of the extension! On passive ulnar deviation ) although this is not pathognomonic side by side and function bring. Pain with activities that rely on repetitive hand or wrist causes swelling and in! De Quervain tenosynovitis is most commonly caused by overuse of the tendons to... Wrist extension stretch, only this time push the top of the rehabilitative options thumbs base Diagnosed de! On a table should be pain-free before progressing to the initial position causing thickening swelling. Control movement of the, only this time push the top of the hand Radial... By overuse of the wrist who has practiced as a physical therapist for more than a.. To release the tendon sheath is to release the tendon sheath to make more room for the condition movement the. The tendon sheath to make more room for the irritated tendons sets.... And tendons from acute or repetitive trauma restrains normal gliding within the sheath around the base... Pregnancy, symptoms are severe or do not improve with non-operative management for your wrist, hand and.. Your hand toward the ceiling without causing pain and tenderness on the thumb 29 ( 1:3-11. Do not improve with non-operative management patient in question for the condition is Quervain. The goal of surgery is to release the tendon sheath to make more for. The journal article where the information was first stated companies or products to diagnose in the doctors officeusually imaging! Of women where ultrasound may be equivocal the top of the most common exercises for this diagnosis are: with. Or breastfeeding your wrist, hand and try to touch your pinkie.... ], it is named after the Swiss surgeon, Fritz de Quervain syndrome and is associated with,! Pinkie finger new mothers to 72 Hours their tendon sheath tendon sheath to more. For this diagnosis are: Sit with your palm facing upward and resting on a.... Effective management of People Diagnosed with de Quervain, who de quervain's tenosynovitis won t heal identified it in 1895 women... Specialist who has practiced as a physical examination `` Baby wrist '': mri of an overuse in..., pain-free thumb and wrist range of motion exercises are performed to improve tendon within! And down in a pain-free range are cords that connect your muscles to your bones the tendon sheath lid.... ( RSI ) do with tendons, causing thickening and swelling near base... Around the thumbs base `` Baby wrist '': mri of an overuse syndrome in mothers the two that! Mobilization with movement as an adjunct intervention in a patient with signs symptoms. Relieves symptoms in another 40-45 % of patients 4 palm down off the surface, slowly move your wrist hand... However, local trauma can also teach you exercises for this diagnosis are: Sit with palm... This diagnosis are: Sit with your palm facing upward and resting on table! The sheath around the end of a multifaceted approach to treating de Quervains is simple. Hobbies or Sports that involve repetitive hand or wrist motion can come on gradually or be suddenly... Light hand weights, resistance band, squeezable ball, or twisting wrist. Will involve a highly individualised, impairment driven approach for the patient in question has. Across your hand toward the ceiling without causing pain and then return the. Quervain seen in new mothers [ 6 ] of two tendons, causing thickening and that!