A common condition of inflammation around the tendons on the thumb side of the wrist.
Tendons are cord like structures connecting muscles to bone.
They pass under a strap of tissue ( called a retinaculum) which holds the tendons in place & prevents bowstringing.
In effect the tendons pass through a tunnel which is lubricated by the fluid produced by a thin layer of tissue called tenosynovium.
When this tissue is inflamed it is called "tenosynovitis”.
Multiple small branches of the Radial nerve pass through the region at the base of the thumb & are occasionally involved in the inflammation in this region.
Cause
Usually highly repetitive movements of the wrist & thumb such as lifting , grasping & twisting.
It is very common in mothers or grandmothers lifting young babies (See below).
It may also occur in more generalised conditions such as Diabetes and some types of inflammatory arthritis.
Symptoms
Pain on the thumb side of the wrist.
Sometimes there is swelling or a cyst develops.
When severe there may be catching or snapping with thumb movement or numbness on the back of the thumb & index finger.
Treatment
The early treatment is aimed at reducing the pain and inflammation in the area of the tendons.
Activity modification, Anti-inflammatories, Splints and Ice can help to achieve this goal.
1. Rest or Activity Modification
Avoid or modify any task that increases your discomfort. Tasks may need to be spaced over the day or modified.
For example:
- Share the load, request help where possible and leave tasks that can wait.
- Avoid gripping or lifting objects in a manner that bends your wrist sideways, e.g. lifting a saucepan by the handle or opening jars.
- Use both hands where possible.
- Some objects can be carried more easily on a flat palm e.g. a dinner plate.
2. Anti- inflammatory tablets eg Voltaren
(should be taken with food to prevent
stomach irritation)
3. Anti - inflammatory creams - (eg Diflam
cream, Indospray, Voltaren gel )
4. Ice pack– use for 10 – 15 mins especially after repetitive activities. Ice can be also be made using a disposable paper cup. This can be stored in the freezer and applied directly to the skin using a rubbing motion for 1 – 2 mins. Protect your skin from an ice burn by massaging with a little oil. Beware not to burn the skin with the ice.
5. Splints - from physiotherapist
The splint should support both the wrist and thumb. Initially it should be used continuously for several weeks. It can then be used just when you are doing repetitive activities until the condition settles.
6. Cortisone injections (Injection Technique)
7. Operation - De Quervains Release
- Remove inflamed tissue & release and lengthen the retinaculum so there is more room for the tendons.
De Quervains Operation Details
De Quervains Post Operative Instructions
De Quervain’s Tenosynovitis with young babies
Carers of babies and young children (Often mothers and grandmothers) commonly experience De Quervain’s Tenosynovitis.
This condition often persists until the baby starts walking.
It therefore often needs to be managed for 6 - 9 months.
Often the best initial treatment is a Cortisone injection which rapidly provides relief.
Other measures to control the condition and prevent recurrence after an injection include:
- Avoid picking up your baby with thumb extended. Try scooping your baby up with your forearm.
- Try to keep your wrist in mid position when holding your baby
- Try carrying your baby in a sling
- Support the baby on a pillow when feeding. If you are having difficulty establishing feeding due to your wrist/thumb pain your Baby Health Centre may be able to assist with positioning ideas.
- Choose clothing for yourself and your baby that have minimal fasteners
Revised 1 / 10 / 2021