The tendons in the body are covered with a special sheath. This covering helps to protect the tendons and allows them to be bathed in a fluid that lubricates them when performing their normal functions. Inflammation of the tendons is a common problem and causes pain and potential disability. This article addresses a specific wrist tendinopathy. De Quervain’s (di kewr VAINS) tenosynovitis is a tendinopathy that causes pain at the base of the thumb. If not treated, it can become chronic and limit hand and thumb activity.
What are the Symptoms of de Quervain’s?
Symptoms of this condition begin by pain developing at the base of the thumb. This may be the first indication of tenosynovitis. With progression of the problem, swelling may be noted along with limitation of motion due to pain in the thumb. There is a general difficulty with movement of the thumb. If a body fever and redness develop at the site of a cut or puncture wound of the tendon, this indicates a medical emergency and you need to be seen immediately as an infection of the tendon or injury site may be occurring.
De Quervain’s is most common in middle aged women and diabetics. The condition is very different from the carpal tunnel syndrome.
What are the Causes of Wrist Tenosynovitis?
Tenosynovitis may come on gradually and the cause may be unknown. However, there are known causes and these include:
- Repetition or Overuse – Work, recreation or hobbies that use the tendons of the thumb repetitively may be a factor. This includes repetitive pinching of the thumb. Gardening is a common cause from pulling weeds and picking produce.
- Injury or Strain – Sudden trauma or a strain to the tendon that results in inflammation of the tendon sheath.
- Rheumatoid Arthritis – An inflammatory arthritis that can affect the tendons around a joint.
- Infection – Lacerations, punctures or cuts to the tendon area that may produce tenosynovitis are medical emergencies and treatment is not within the scope of this article.
How is de Quervain’s Diagnosed?
The doctor will take a history to begin to determine the reason for the onset of symptoms. Examination of the wrist to include a special diagnostic orthopedic test can confirm the presence of tenosynovitis. This test is called Finkelstein’s and is demonstrated below:
This maneuver stretches the irritated tendons producing a “positive test”. X-rays are of little value. A MRI may show the inflammation but is very expensive and wouldn’t add anything to the findings.
How Can Conservative Treatment Help?
The initial goal is to reduce the pain and inflammation. Conservative management of the tenosynovitis may include:
- Bracing – The use of a brace to reduce and prevent thumb movement eases the stress on the tendons and prevents the continual irritation to the inflamed tendon.
- Physical Modalities – The use of ultrasound or galvanic current will aid in the reduction of swelling.
- Cryotherapy – Ice application to the tendon reduces inflammation and swelling. The use of ice massage is best for these superficial tendons.
- Anti-inflammatory Medication – Follow the manufacturer’s recommendations for over-the-counter pain and anti-inflammatory medications such as Ibuprofen. You should be aware whether these medications will have an adverse effect on any other medications you are taking. If not certain, contact your primary care physician or pharmacist for information.
After the tenosynovitis has subsided, the next goal is to prevent its re-occurrence. The following is recommended:
- Ergonomics – Review workstation and job activity for modifications. Determine if work can be done with tools or devices other than pinching with the thumb. Use ice immediately after work or other activities that cause a flare-up of symptoms to reduce any potential swelling.
- Upper Extremity Exercise – Perform specific exercises outlined by your doctor to strengthen and maintain motion to the wrist and thumb joints.
The prognosis with the use of conservative management is good. There are those times when more aggressive treatment may be necessary. The importance of modifying the activity that contributed to the tenosynovitis cannot be stressed enough.
The doctors at Coon Rapids Chiropractic Office have experience in the care and treatment of de Quervain’s stenosing tenosynovitis.