De Quervain's Tendinosis
The bones that make up the hand and the wrist provide the body with support and flexibility in order to manipulate objects in many different ways. With the support of the ulna and radius of the forearm that support many of the hand’s muscles, the 27 bones in the hand have an incredibly precise range of motion. The hand can be considered in four segments:
- Fingers – digits that extend from the palm of the hand, making it possible to grab the smallest of objects
- Palm – the “high-five” side of the hand
- Dorsum – the back side of the hand where a web of veins is often visible
- Wrist – the point of connection between the hand and the forearm which facilitates proper motion of the hand
These four segments, along with a network of muscles, tendons, and tissues work cohesively to enable the hand to perform the most complicated activities. Unfortunately, like the rest of the body, hands and wrists are susceptible to number of different injuries and conditions.
Tendons are rope-like structures that attach muscle to bone and are covered by a thin soft-tissue layer, called synovium. The synovium lubricates the tendons, enabling them to easily slide through a fibrous tunnel called a sheath. Swelling of the tendons as well as the sheath can cause significant pain and tenderness along the thumb-side of the wrist. De Quervain’s tendinosis occurs when these tendons are irritated or inflamed and is clearly noticeable when forming a fist or grasping something. The exact cause of De Quervain’s tendinosis is unknown, but repetitive hand and wrist movements can worsen the symptoms.
Signs and symptoms of De Quervain’s tendinosis include:
- Gradual or sudden pain along the thumb-side of the wrist that can travel up the forearm and worsens with activities involving the hand and wrist
- Swelling or tenderness that may be accompanied by a fluid-filled cyst over the thumb-side of the affected wrist
- Sticking or “catching” sensation when moving the thumb
- Difficulty or inability to move the thumb or wrist when performing activities involving grasping or pinching
Left untreated, the pain caused by De Quervain’s tendinosis can spread farther into the thumb and/or back of the forearm. Therefore, it is strongly advised to visit a physician if an individual experience any of the aforementioned symptoms or suspect the presence of De Quervain’s tendinosis.
Diagnosis of De Quervain’s tendinosis is generally made entirely upon a physical examination. The physician may conduct the Finkelstein test by instructing the individual to place the thumb against the hand, make a fist with the fingers closed over the thumb, and then bend the wrist toward the little finger. If this causes pain on the thumb-side of the wrist, De Quervain’s tendinosis is highly likely.
Early diagnosis of De Quervain’s tendinosis will typically respond quite well to non-operative treatment. The main objective of treatment is controlling inflammation and reliving the pain caused by the irritation and swelling. Operative treatment is always a last resort after non-operative approaches have been exhausted.
Medication – Pain relief medication such as acetaminophen as well as non-steroidal anti-inflammatory medicines (NSAIDs) can significantly reduce pain and swelling.
Splint – The physician might recommend the use of a supportive splint worn over night or throughout the day to limit the movement of the thumb in order to allow the joint to rest and heal naturally.
Steroid Injections – Injecting the thumb joint with cortisone, a powerful anti-inflammatory medicine, can be curative in many cases, but does not always relieve the pain.
Surgery – Surgery may be an option when more-conservative treatments don’t relieve pain caused by severe De Quervain’s tendinosis. The goal of surgery is to open the thumb compartment to create more space for the irritated tendons to move within the sheath. Options must be discussed extensively with the physician to identify the appropriate surgical procedure.
Recovery, especially after a surgery, can take several weeks if not months. Each patient is unique and their recover will depend on the treatment method prescribed by the physician. Regardless of the treatment option chosen, once the strength and comfort return individual may return to their normal level of activity.
CALL 911 IMMEDIATELY IF YOU ARE HAVING A MEDICAL EMERGENCY!
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