One of the most common causes of thumb and wrist pain is due to tendonitis. De Quervain’s tenosynovitis is a type of tendonitis that is frequently seen in young mothers. This causes pain on the thumb side of the wrist. The pain is worse with movement of the thumb and wrist at the same time. Opening jars, turning doorknobs, and caring for a young child can be difficult.
When there is irritation of the tendons in the wrist, the pain can occur. Normally, tendons glide smoothly in the hand and wrist. In de Quervain’s tenosynovitis, the tendons have friction around them, and they become inflamed and painful. Patients feel pain in the thumb-side of the wrist. Certain movements of the thumb and wrist can be excruciating. Patients may see wrist swelling or feel a tender bump in this area. Occasionally, popping around the tendons is noticed by the patient.
The cause of de Quervain’s tenosynovitis is usually unknown. Symptoms can start after a new repetitive activity. The condition is common in women, especially pregnant women and mothers of young children. It has been called “mommy’s thumb” or “mommy’s wrist” because of this.
De Quervain’s tenosynovitis can be diagnosed by symptoms and examination in a doctor’s office. An x-ray can sometimes be helpful to rule out other conditions such as arthritis or wrist fracture.
Finkelstein’s test can help confirm the diagnosis. During this exam test, the patient places their thumb into their palm and wraps their fingers around the thumb. Then the patient moves their wrist in the direction towards their small finger (take care, this can be very painful!).
Fortunately, most people improve with time and do not need surgery for de Quervain’s tenosynovitis. Therefore, non-operative treatment is tried first.
Treatment is focused on reducing pain, reducing inflammation, and improving hand function. Wearing a splint that supports and immobilizes the thumb and wrist (“thumb spica brace”) can help reduce symptoms. Off-the-shelf and custom-made braces are available. Resting the hand by avoiding repetitive thumb motion and forceful gripping may reduce the irritation. Anti-inflammatory medications such as Ibuprofen, Naproxen, and Tylenol can reduce pain. Topical gels can reduce pain and inflammation. Hand therapists can teach stretching exercises and reduce pain with modalities such as iontophoresis treatment. Adjusting how you use your hand can help.
Many people can be cured with one or two cortisone shots. Corticosteroid injections are very effective in reducing or eliminating symptoms in approximately 70-80% of patients. The risks of corticosteroid injection (also called a “cortisone shot”) are pain, infection, skin color change, and, rarely, thinning of the skin at the injection site. Diabetics should be aware that blood sugars can be increased for a few days after a cortisone shot. Also, multiple injections should be avoided as they can weaken the soft tissues over time.
Non-Surgical Treatments• Topical medications
If these non-surgical treatments do not improve the symptoms, surgery may be recommended. De Quervain’s release surgery is performed to improve the gliding of the tendons with the goal of reducing pain. During this procedure, the tight sheath (extensor retinaculum) is opened through a small incision on the thumb-side of the wrist. Results from this surgery are excellent in most cases. The recovery often takes about six weeks after surgery.
Dr. John M. Erickson is a hand and upper extremity specialist at the Raleigh Hand Center. He trained in orthopedic surgery at the University of Michigan and completed a hand surgery fellowship at Vanderbilt University. He is an active member of the American Society for Surgery of the Hand (ASSH).