Thumb Pain from De Quervain’s Tenosynovitis
Posted on Thu, Jul 09, 2009 @ 09:08 AM
De Quervain's Tenosynovitis (D-quare-vanes T-no-sigh-no-vie-tis) is an inflammation of the synovial tissue that covers the tendons that straighten and pull the thumb away from the hand ("hitchhiker" position). The tendons involved are the ones along the thumb side of the wrist that are prominent when the thumb is extended away from the hand. Inflammation of the tendons or of the tissue that surrounds them causes swelling and restricts the tendons' ability to glide back and forth when the thumb moves.
The most common cause of de Quervain's Tenosynovitis is overuse from lifting or performing side to side motions with the hand. Sometimes the condition develops for no known reason. Treatment is the same if the cause is known or not.
Pain along the thumb side of the wrist is the most common symptom of de Quervain's tenosynovitis. The pain may radiate down to the end of the thumb or up along the thumb side of the forearm. Pain is felt when reaching the thumb across the palm or when flexing (bending) the wrist and turning it towards the little finger as with a hammering motion.
The most common treatment for de Quervain's is anti-inflammatory medications and rest as a first step. A Thumb Spica Splint that extends the thumb and holds the wrist in a neutral position limits the motions that cause pain.
Depending on the severity of the condition, different splints provide varying degrees of immobilization. For mild or occasional symptoms, a soft wrap-on splint may be enough to provide rest and a reminder to avoid aggravating positions. A molded splint, either an off the shelf variety or custom made by a therapist, may be needed to calm more severe symptoms. Care should be taken to choose a splint that fits well and that holds the thumb in a rested position. Wrist splints designed for Carpal Tunnel Syndrome will not be helpful with de Quervain's.
In addition to a splint, a health care provider may do a cortisone injection around the tendon to relieve more severe inflammation and pain. The splint should be worn for a few days after the injection to give the cortisone time to be most effective. In persistent cases of de Quervain's, surgery may be necessary to relieve scarring and tethering of the tendons.
Author: Julie Belkin