Introduction
De Quervain’s syndrome is when the tendons (rope-like structures that attach muscles to bone) along the base of the thumb and side of the wrist become irritated or constricted.
Reproduced from: Griffin LY (ed): Essentials of Musculoskeletal Care, 3rd Edition. Rosemont, IL. American Academy of Orthopaedic Surgeons, 2005.
This may result in inflammation, resulting in swelling, pain, and tenderness.
These symptoms may in turn lead to:
- Pain and weakness with gripping, clenching, pinching and wringing motions
- “Crepitus”, “catching”, or “stop and go” sensations whilst moving the thumb
- Reduction in thumb / wrist joint movement
Untreated De Quervain’s syndrome may cause difficulty in using your hand and wrist properly. The pain may travel from the thumb up to the forearm and could become significantly disturbing. Thumb movements and wrist will become stiffer.
What Actually Happens?
The thumb tendons involved are the extensor pollicis brevis and abductor pollicis longus, which are located side by side. They are covered by a slippery, thin soft tissue sheet called synovium.
When you move your thumb, both tendons will normally glide smoothly through a small fibrous tunnel (tendon sheath) that holds them down to the base of the thumb of the wrist.
However, repeated motions over a short period of time may irritate the tendons, or the tendon sheath / synovium around the two tendons. This causes friction, thickening, and swelling that restricts thumb and wrist movement, and causes pain.
Common Causes
The most common cause appears to be chronic overuse or excessive repetitive motions of the thumb and hand. Some examples of activities involve these are:
- Wringing wet cloth/clothes
- Texting on mobile phones
- Computer keyboard use
- Hammering
- Console gaming – joystick use
- Piano or drum playing
- Gardening
- Lifting heavy objects such as kettle or frying pans
- Baby care – using the thumb for leverage while lifting or carrying the infant
Other possible causes could involve:
- Inflammatory arthritis such as rheumatoid arthritis
- Direct trauma to the thumb and wrist
- Scar tissue from a previous wrist injury (scar tissue can impede tendon movement)
Diagnosing the Condition
The Finkelstein Test is a common maneuver that helps diagnose De Quervain’s syndrome.
To perform the test:
- Wrap the thumb in a closed fist
- Tilt the hand downwards
Reproduced from: https://esportshealthcare.com/wp-content/uploads/2019/11/gamers-thumb-finkelstein.png
The test is positive if a sharp pain is produced at the base of the thumb or side of the wrist.
Conservative Treatment
- Avoid/reduce / modify the painful activities
- Splint to rest and immobilize thumb and wrist (usually 24 hours for 4-6 weeks)
- Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain control and inflammation
- Corticosteroids injection (reserved for persistent pain)
- Physiotherapy for active pain relief and recovery, strengthening and return to daily activities
Physiotherapy and Rehabilitation
Recovery Goals
- Pain reduction and inflammation control using modalities and massage
- Improve mobility and restore function with rehabilitative exercises
- Lifestyle modification with advice on thumb and wrist positioning to minimize strain on the inflamed tendon in daily tasks
Surgical Intervention
If the above conservative measures are not effective after several weeks, surgery may be recommended to reduce pressure on the tendon by cutting open the tendon sheath.
