De Quervain's Tenosynovitis
Though the name sounds exotic, de Quervain’s tenosynovitis—a condition caused by constriction or pinching of the wrist tendons at the base of the thumb—can arise from such simple tasks as lifting a laundry basket, putting away groceries, or even lifting babies. The condition is named after the Swiss surgeon who first identified it. The constriction can lead to swelling and pain that makes daily activities difficult.
Noting that de Quervain’s is most common in women between the ages of 30 and 50, J. Grant Thomson, MD, director of Yale Medicine’s Hand & Microsurgery Program, says he sees it most often in women, but usually cannot identify a specific cause. “The condition may be associated with repetitive stress, pregnancy, or rheumatoid arthritis, but often just appears for no apparent reason” he says.
How does de Quervain’s develop?
More research is needed to understand the exact cause of de Quervain's tenosynovitis. Doctors know that the symptoms are caused by a compression of two tendons (that attach muscle to bone) that pass through the wrist near the lower thumb on the way to the hand. The compression causes pain with activities that rely on repetitive hand or wrist motion.
What are the symptoms of de Quervain’s?
People with de Quervain’s typically experience pain in the wrist while pinching, grasping, making a fist, or stretching the wrist towards the small finger. Swelling and stiffness can also occur.
Sometimes de Quervain’s also brings pain and swelling near the base of the thumb. The pain may even radiate to the forearm.
How is de Quervain’s diagnosed?
De Quervain’s is relatively simple to diagnose in the doctor’s office—usually no imaging tests are needed. First, your doctor will examine your hand, applying pressure to the wrist near the base of your thumb. A technique specifically designed to test for de Quervain’s is called the Finkelstein test. It involves first bending the wrist toward the baby or “pinky” finger, then bending the thumb across the palm.
If the test is done correctly, people with the condition will feel pain in the area surrounding the thumb.
How is de Quervain’s treated?
Wearing a splint that immobilizes your thumb and part of your wrist may help control the pain associated with thumb movement. You may also find it helpful to avoid (or minimize) certain activities that put stress on your wrist. Over-the-counter anti-inflammatory medications can provide pain relief. If needed, the doctor can administer steroid injections to reduce your symptoms. Steroid injections may provide only temporary or incomplete relief from pain.
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. Surgery is performed in an outpatient setting and usually provides permanent relief.
How is Yale Medicine unique in the treatment of de Quervain’s?
The Yale Medicine Hand and Microsurgery Program is among the most comprehensive in the area for evaluation, diagnosis, and treatment of both simple and complex conditions of the hand, wrist, and forearm.
Our specialists work together to determine the best approach to diagnosing and treating even the most complex injuries, abnormalities, or diseases. Many patients who come to Yale Medicine find that treatment improves their hand function dramatically.
The Center for Musculoskeletal Care McGivney Advanced Surgery Center is a state-of the art facility staffed with expert nurses, anesthesiologist, surgeons, and support staff devoted to patient comfort and well-being before, during, and after surgery so that anxiety, pain, and recovery time are minimized.