Causative and risk factors
The exact cause of this condition is not known. However any repetitive activity that stresses the wrist joint worsens the pain. Direct injury to the tendon can also cause tenosynovitis.
Middle aged adults are more prone for this condition. Women are more commonly affected than men.
Clinical presentation
The base of the thumb is painful and swollen. The pain may radiate to the forearm. The thumb movements become difficult. The thumb becomes stuck in certain positions. Movements of the wrists which involve the thumb become difficult.
Diagnosis and investigations
De Quervain’s tenosynovitis is a clinical diagnosis made by the physician on the basis of patient’s medical history and physical examination. No specific laboratory or imaging tests are necessary.
The doctor will perform the Finkelstein test while examining the patient to confirm De Quervain’s tendinosis. The patient is asked to make a fist whilst closing the thumb against the palm. The wrist must be bent laterally towards the little finger. This lateral bend triggers intense pain in the tendon along the thumb side of the wrist. A positive Finkelstein test confirms De Quervain’s tendinosis.
Treatment
The patient is advised to immobililize the thumb as far as possible, and use ice packs.
Medications are prescribed to reduce pain and inflammation. Severe pain indicates the use of intra-tendon injections.
Physical therapy is recommended to restore the thumb movements.
Severe cases may need surgery in which the doctor will open up the tendon sheath so that the tendon can glide freely again and the pain stops.
