de Quervain's Tendonitis - Wrist Tendonitis 

Introduction
De Quervain’s Tendonitis is a condition caused by an inflammation of the tendons located at the thumb side of the wrist.  Tendons are tissues that attach our muscles to our bones.  They can become swollen and sore from over use.  Traditionally, de Quervain’s Tendonitis was called “Washer Woman’s Syndrome.”  This is because the repetitive hand movements used for wringing wet clothes-- thumb pinching, squeezing, and moving the wrist outwards towards the little finger, are the motions that can cause de Quervain’s Tendonitis.

Back to Top

Anatomy
Two of the tendons that move our thumb are involved in de Quervain's Tendonitis. The tendons pass through a tunnel, called a tendon sheath, and connect two muscles from our forearm to our wrist.  The two muscles are called the Extensor Pollicis Brevis and the Abductor Pollicis Longus.  These muscles allow our thumbs to move upwards and away from the hand.  We use these movements to pinch, grasp, or squeeze objects.  These muscles also allow our hand to move towards the side of our little finger, such as when we wave from side to side.

Back to Top

Causes
Doctors do not know what causes de Quervain’s Tendonitis.  It may be produced by an irritation of the tendons at the base of the thumb. 
 
Repetitive thumb motions and wrist deviation, moving the wrist towards the side, can irritate the tendons when they move through the tendon sheath.  Activities that require such motions include wringing laundry, gardening, and the awkward hand movements required for lifting and caring for a new infant. 
 
Over use can cause the tendons to swell and accumulate fluid, resulting in a condition called Tendonitis.  The lining of the tendon sheath can also become inflamed.  This condition is called Tenosynovitis.  Tendonitis and Tenosynovitis can occur independently or at the same time. 
 
Tissue swelling associated with metabolic disorders, such as diabetes and rheumatoid arthritis, may also cause de Quervain’s Tendonitis.  It appears to have a tendency to develop during pregnancy or menopause, times when fluid may be retained.  Doctors also believe that de Quervain’s Tendonitis may be caused by direct trauma to the wrist or by a sudden strain from lifting or unaccustomed exercise. 

Back to Top

Symptoms
The main symptom of de Quervain’s Tendonitis is pain at the thumb side of the wrist.  You may also feel pain in your forearm.  The pain can occur suddenly or gradually.  The pain will usually become worse when you use your thumb and wrist to perform grasping and pinching motions.  If the nerve that lies on top of the tendon sheath is irritated, it can cause the back of your thumb and index finger to feel numb. 
 
De Quervain’s Tendonitis can also cause swelling at the wrist and thumb area.  Some individuals develop a fluid-filled cyst in this region.  You may hear crackling noises or feel a catch when you move your thumb.  Some people have difficulty moving their thumb and wrist.

Back to Top

Diagnosis
Your doctor can diagnose de Quervain’s Tendonitis by examining your wrist and hand.  Your doctor will also ask you about your symptoms and activities.  The Finkelstein test is a common physical examination used to confirm a suspected case of de Quervain’s Tendonitis.  The test is simple to perform.  Your doctor will ask you to make a fist with your thumb tucked inside.  Next, you will bend your wrist towards the little finger side of your hand.  The test is positive if you feel pain at the base of your thumb. 

Back to Top

Surgery
The goal of surgery is to increase the movement of your fingers and restore their correct positions to improve hand functioning.  This may be attained in several different ways.  Your surgeon may simply divide the thickened bands in a procedure called fasciotomy.  The sheet of diseased palmar fascia may also be removed, and is called a fasciectomy.  In some cases, a skin graft may be necessary.
 

Back to Top

Treatment
There is no way to stop the progression of Dupuytren’s disease.  Your doctor will monitor the progress of your disease.  Injections may help relieve the pain in a lump that has formed early in the disease process.  Injectable enzymes to dissolve the diseased tissue are being studied, but are not yet commercially available.  Surgery is recommended if the fingers become flexed enough to interfere with the functional use of your hand.
 
Following surgery, you will participate in rehabilitation.  You will receive therapy treatments to aid wound healing, reduce swelling and ease pain.  You will be instructed in strengthening and stretching exercises.  You will perform hand coordination exercises and work towards improving your hand grip and finger pinching skills.  Your therapist will provide you with a splint to position your hand and promote healing.

Back to Top

Recovery
Surgery is not always a permanent solution for Dupuytren’s Disease.  The condition tends to gradually recur over time. 

Back to Top

 

Copyright ©  - iHealthSpot, Inc. - www.iHealthSpot.com

This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on April 13th, 2016. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.