De Quervain's Tenosynovitis

De Quervain's tenosynovitis is irritation and swelling of two thumb tendons and the narrow tunnel they pass through at the thumb side of the wrist. Repeated stress inflames the sheath around the tendons, the tunnel grows crowded, and the tendons can no longer slide freely, so every thumb motion produces pain over the bony bump at the base of the thumb side of the wrist. The tendons themselves are not torn; the problem is inflammation and swelling. Because of that, the condition often responds well to treatments that reduce inflammation and give the sheath time to settle.

Common symptoms include:

• Sharp pain over the bony bump on the thumb side of the wrist with gripping, pinching, or twisting
• Pain first noticed when lifting a child with the thumb out and the wrist bent toward the little-finger side
• Visible swelling or a small firm bump over the tendon tunnel
• A catching or squeaking sensation as the tendons slide through the narrowed tunnel
• Pain that can radiate up the forearm or into the thumb, with a weaker grip

The diagnosis is made from a focused exam of the wrist and thumb that reproduces the pain at the bony bump on the thumb side. Ultrasound can confirm swelling of the tendon sheath and is also useful for guiding an injection accurately. X-rays are added to rule out arthritis at the wrist or thumb base, which can produce similar symptoms.

Most cases settle with nonsurgical care aimed at reducing inflammation and taking load off the tendons:

• A thumb spica splint that holds the wrist and thumb still during the acute phase
• Activity changes to avoid repetitive pinching and side-to-side wrist motion
• A corticosteroid injection into the tunnel, guided by ultrasound, which is highly effective
• Anti-inflammatory medication and ice for acute pain alongside the splint

Surgery is reserved for cases where nonsurgical treatment, including injections, has not provided lasting relief, or where the tunnel has thickened to the point that injections are unlikely to help. The procedure releases the roof of the tunnel to give the tendons more room.

For a fuller explanation, including anatomy, diagnosis, and the full range of treatment:

• De Quervain's Tenosynovitis — AAOS OrthoInfo