De Quervain's Tenosynovitis

What it is

De Quervain's tenosynovitis causes painful tendons on the thumb side of the wrist. The tendons run through a tunnel (the first extensor compartment) that can narrow, or the tendons and their lining can take up extra room, so thumb and wrist motion, especially forceful grasping or twisting, becomes painful.

What causes it

The exact cause is not known. Repetitive hand use, hormonal changes, and swelling are likely factors. In new mothers it typically appears four to six weeks after delivery.

Symptoms

• Sharp or dull pain at the base of the thumb or the thumb side of the wrist
• Swelling over the tendons
• Pain with grasping, pinching, or twisting

Diagnosis

De Quervain's is diagnosed by examination, including a simple maneuver with the thumb tucked inside a fist that stretches the tendons (the Finkelstein test).

Treatment

Without surgery: a splint that rests the thumb and wrist, acetaminophen or anti-inflammatory medication, a corticosteroid injection into the tendon compartment, and hand therapy once symptoms ease.

Surgery: if these do not help, an outpatient procedure opens the tunnel to give the tendons more room.