Signs and Symptoms
- Pain at the base of the thumb extending into the wrist and forearm
- It is associated with activities using the thumb and wrist
- Swelling and possible redness on the thumb side of the wrist
- Occasional clicking sound with wrist motion
Diagnosis
- This is a relatively easy diagnosis to make by history and physical exam alone
- Occasionally an MRI is obtained to confirm the diagnosis
Background
DeQuervain’s Tenosynovitis is the name of a specific inflammation involving two tendons located at the wrist, near the base of the thumb. It is often misrepresented as a tendonitis, but actually affects the tunnel, or “sheath,” that the tendons run through on their way from the forearm to the thumb. These two tendons, and the muscles that they originate from, allow us to extend our thumbs upward and to the side. Activities that require repetitive wrist or thumb use can contribute to DeQuervain’s, such as lifting/carrying, sewing, cutting with scissors, gardening/pulling weeds, laundry/folding towels, and others.
Treatment
Conservative (Non-Surgical)
- Oral anti-inflammatories (NSAIDS such as Advil or Aleve)
- Splint to rest the area
- Corticosteroid injection for more severe pain (No more than a total of two injections would be recommended given the potential side effects of the corticosteroid)
- Hand Therapy
Surgery
For when the patient has continued pain despite trying the conservative treatment.
- This involves opening a portion of the sheath to reduce the constrictive pressure around the tendons.
Hand Therapy
Weeks 1-2:
- The hand therapist or physician will remove the post-op dressings.
- Specific forearm, wrist, hand, and thumb exercises will be prescribed, for completion in therapy and as part of your home program. Achieving/maintaining full range of motion is emphasized.
- Swelling and scar management techniques are initiated in therapy. Your therapist will also perform various manual techniques to minimize nerve hypersensitivity, as there is a sensory nerve very close to the incision site.
- A removable thumb splint may be made for you. Follow the instructions of your physician and therapist if this is provided.
Swelling is fairly minimal after this procedure, and usually resolves within 1-2 weeks. Mild discomfort will be present in the first few days after surgery, but overall, pain levels should be much lower now than before surgery.
Weeks 3-4:
- Once good pain-free range of motion is restored, gentle strengthening will be initiated. Therapy may continue on a limited basis, but typically not past 4-5 weeks post-op. In-office therapy will continue to emphasize scar softening/flattening, swelling management, and safe return to activities.
