KnowYourDisease.Com De Quervain's Tenosynovitis, Causes, Definition, Diagnosis, De Quervain's Tenosynovitis Symptoms, De Quervain's Tenosynovitis Treatment, Emedicine, De Quervain's Tenosynovitis Surgery, Dequervain's Tenosynovitis Surgery, Tenosynovitis Syndrome, Tenosynovitis Therapy
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Tenosynovitis, De Quervain's

Definition:
Working in the garden, playing a musical instrument, knitting, cooking and walking your pet can all be enjoyable activities, but if these activities cause pain in your wrist and hand, you may have a condition known as de Quervain's tenosynovitis. This inflammation affects the sheaths of the tendons on the thumb side of your wrist.

Whenever you grip anything with your hand, you actively use two major tendons in your wrist and lower thumb. In de Quervain's tenosynovitis, the sheaths of the tendons are inflamed or swollen, thus restricting the tendons' movement, like trying to maneuver your arm through a sleeve that's much too tight. The result with de Quervain's tenosynovitis is discomfort and pain every time you turn your wrist, grasp anything or make a fist.

Treatment for de Quervain's tenosynovitis may range from immobilizing your wrist and taking over-the-counter medications for a while to surgery in more serious cases. If started early on, treatment for de Quervain's tenosynovitis is generally successful.

Causes:
When you grip, grasp, clench, pinch or wring anything in your hand, you use two major tendons in your wrist and lower thumb. These tendons of the abductor pollicis longus and the extensor pollicis brevis muscles run side by side from your forearm through the thumb side of your wrist. They normally glide unhampered through the small tunnel that connects them to the base of the thumb. In de Quervain's tenosynovitis, the tendons' slippery covering becomes inflamed, restricting movement of the tendons.

The most common cause is chronic overuse of your wrist. For example, peeling carrots involves a repetitive motion, a bent wrist and the gripping of the peeler. If you peel carrots or potatoes day after day, hour after hour, this combination may be enough to irritate the sheath around the two tendons.

Other causes of de Quervain's tenosynovitis include:
  • Direct injury to your wrist or tendon; scar tissue can restrict movement of the tendons
  • Inflammatory arthritis, such as rheumatoid arthritis
Risk Factor:
People most at risk of de Quervain's tenosynovitis tend to be those whose occupations or hobbies involve repetitive hand and wrist motions, such as carpenters, office workers and musicians. Even the awkward hand and wrist positions that new parents use in holding and rocking their children can cause the condition. De Quervain's tenosynovitis occurs most often in women between the ages of 30 and 50.

When to seek medical advice:
Consult your doctor if you're still having problems with pain or function and you've already tried:
  • Avoiding repetitive thumb movements whenever possible
  • Avoiding pinching with your thumb when moving your wrist from side to side
  • Applying heat to the affected area
  • Using nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve)
If the pain continues to interfere in your daily life or activities, seek medical advice.

Symptoms:
The main signs and symptoms of de Quervain's tenosynovitis are pain and swelling near the base of your thumb. The pain may appear suddenly or may increase over time. If the condition goes too long without treatment, the pain may spread farther into your thumb, back into your forearm or both. Pinching, grasping and other movements of your thumb and wrist aggravate the pain.

Other signs and symptoms of de Quervain's tenosynovitis may include :
  • Numbness in the back of your thumb and index finger, caused by the swollen tendon rubbing on a nerve
  • A fluid-filled cyst in the same region as the swelling and pain
  • Difficulty moving your thumb and wrist when you're doing activities that involve grasping or pinching
  • A "sticking" or "stop-and-go" sensation in your thumb when trying to move it
  • A squeaking sound as the tendons try to move back and forth through the inflamed sheaths
Dignosis:
Your doctor may confirm a diagnosis of de Quervain's tenosynovitis by doing a Finkelstein test. In this simple test, you bend your thumb across the palm of your hand and bend your fingers down over your thumb. Then you bend your wrist toward your little finger. If this causes pain on the thumb side of your wrist, the test is considered positive.

If you feel pain about three inches up your forearm, you may have a condition called intersection syndrome. This is similar to de Quervain's tenosynovitis, but affects a different area of your wrist and requires different treatment.

Complications:

Left untreated, de Quervain's tenosynovitis may permanently restrict movement of the tendons of your wrist, making it difficult for you to bend your wrist, pinch, grasp or make a fist. The tendon sheaths could rupture. Additionally, an underlying infection may spread into your hand or your arm, causing further pain and discomfort.

Treatment:
To reduce pain and swelling, initial treatment of de Quervain's tenosynovitis may include:
  • Immobilizing your thumb and wrist, keeping them straight with a splint or brace to help rest your tendons
  • Avoiding repetitive thumb movements whenever possible
  • Avoiding pinching with your thumb when moving your wrist from side to side
  • Applying heat to the affected area
  • Using nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve)
Your doctor may also recommend injections of corticosteroid medications into the tendon sheath to reduce swelling.

Treatment is generally successful if begun early on, though overuse injuries often recur if you have difficulty discontinuing the repetitive motions that caused the condition in the first place.

Your medical team may include a physical or occupational therapist who may monitor your habits and give suggestions on how to make necessary adjustments to relieve stress on your wrists. Your therapist can also teach you exercises focused on your wrist, hand and arm to strengthen your muscles, reduce pain and limit the irritation of the tendons.

If your case is more serious, your doctor may recommend outpatient surgery. Surgery involves a procedure in which your doctor inspects the sheath surrounding the involved tendon or tendons, and then opens the sheath to release pressure.

Prevention:
If possible, make a conscious effort to avoid repetitive wrist and hand movements and pinching with your thumb when moving your wrist from side to side. That may be enough to prevent de Quervain's tenosynovitis. If you have a job that involves intensive use of your hands or wrists, try to make adjustments in your daily routines to reduce the stress on your wrists.
 
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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