De Quervain’s Tenosynovitis

What is De Quervain’s tenosynovitis?

DeQuervain's Tendinosis
Reproduced with permission from: Griffin LY (ed): Essentials of Musculoskeletal Care, 3rd Edition. Rosemont, IL. American Academy of Orthopaedic Surgeons, 2005.

De Quervain’s tenosynovitis is a condition resulting from inflammation and swelling around a couple of the tendons that run along the thumb-side of the wrist. These tendons are responsible for helping to extend the thumb, and they glide through a protective covering called a tendon sheath. The sheaths are like tunnels lined with a thin membrane called synovium. The synovial lining helps reduce friction as the tendons glide through the tendon sheath.

When inflamed, the synovium is thickened, reducing the amount of space through which the tendons are able to pass. The tendons may swell up secondary to the inflammation, causing them to no longer glide freely through the sheath. In addition to inflammation and swelling, fine fibers of scar tissue can form between the sheaths and tendons.

What are the symptoms of De Quervain’s?

Symptoms include pain and swelling near the base of the thumb, and difficulty moving the thumb and wrist when grasping or pinching objects. This may be accompanied by a sticking or stopping sensation in the thumb. Symptoms can appear suddenly or gradually. If left untreated, pain may spread further into the thumb and back into the forearm.

What causes De Quervain’s?

Though the cause of De Quervain’s is not certain, multiple factors may contribute to its development, including physical aggravation and hormonal changes. De Quervain’s is commonly seen in women 4-6 weeks after childbirth. De Quervain’s is most commonly seen in individuals between the ages of 30-50, and it affects women eight to ten times more often than men.

What are the treatment options for De Quervain’s?

Non-surgical treatment options:

  • Activity modification and oral anti-inflammatories: These treatments can be used in mild cases of De Quervain’s.
  • Therapy and bracing: Visits with a hand therapist, which may include specific treatments over the inflamed tendon sheath, as well as bracing. The appropriate brace must include a portion of the thumb in order to reduce tendon strain.
  • Cortisone injection: Reduces swelling and inflammation in the sheath, allowing the tendon to glide more easily. Important things to know:
    • Success rate for curing the condition is eighty percent (80%) with one to two injections.
    • If the first two injections do not work, a third is not likely to help.
    • Injections do not work as well in patients with diabetes.
    • Injections are usually the most cost-effective form of treatment for De Quervain’s.

Surgical treatment option:

Treatment for DeQuervain's Tendinosis
Reproduced with permission from OrthoInfo. © American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org.

Known as first dorsal compartment release, this procedure involves releasing the tendon sheath, which relieves the constriction of the tendons as they pass though the sheath. Frequently asked questions and answers about this procedure include:

How is first dorsal compartment release performed?

  • A small transverse incision is made just below the bony protrusion of the thumb, and the first dorsal compartment is opened.
  • The incision is closed with absorbable sutures. A splint covered with an ace wrap is applied.

How long will it take to recover from surgery?

  • Dressing will remain on the hand for 10-14 days.
  • A custom fabricated splint, made by a therapist, must be worn for 3-4 more weeks following removal of the operative dressing.
  • Activities are allowed as long as they are comfortable.
  • Some patients require formal therapy once the period of bracing is done.

Will this surgery relieve the symptoms?

In most instances, pain is relieved, and the risk of recurrence is very small.

For more information about what to expect before, during and after first dorsal compartment release surgery, click the button below:

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