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De Quervain's Tenosynovitis

This information describes the causes, symptoms, and treatment of de Quervain's tenosynovitis (da-cur-vains teno-sin-o-vitis).

De Quervain's tenosynovitis is a common and painful condition that affects the tendons of the wrist. A protective covering (sheath) wraps around these tendons so that
they can slide easily (see figure). This allows you to turn your wrist and grip and pinch with your hand. With de Quervain's tenosynovitis, the tendon sheath becomes inflamed and swollen. This causes pain and limited movement in your wrist and thumb.

Your doctor can make a diagnosis of de Quervain's tenosynovitis based on your symptoms and a physical exam. He or she will also ask you to perform certain movements with your hand, wrist, and thumb.

X-rays of the area are usually not needed.

Causes

  • Overuse of the wrist over time
  • Repetitive movements involving the wrist, such as:
    • Typing
    • Knitting
    • Using a hammer
    • Holding an infant for a long time
    • Carrying heavy grocery bags
  • Strain or injury to the wrist area
  • Infections
  • Conditions that cause inflammation throughout the body, such as rheumatoid arthritis

Symptoms

  • Pain at the side of your wrist beneath the base of your thumb; moving your thumb can increase this pain
  • Numbness in the back of your thumb and index finger
  • Wrist pain that has spread into your forearm and thumb
  • A pulling or sticking feeling in your thumb when you try to move it
  • A crackling, snapping, or squeaking noise when you move your hand
  • Mild swelling and redness at your wrist
  • A fluid-filled cyst near the thumb side of your wrist

Treatment

The goals of treatment are to:

  • Reduce pain and inflammation
  • Maintain normal joint function
  • Prevent the condition from returning

Depending on your symptoms, your doctor may recommend the following treatments:

  • Avoiding the following:
    • Activities that cause pain
    • Repetitive thumb and wrist movements
    • Making a pinching position with your thumb when you move your wrist
  • A splint to keep your thumb and wrist still
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve your pain and inflammation, such as:
  • Ibuprofen (Advil®, Motrin®)
  • Celecoxib (Celebrex®)
  • Naproxen (Aleve®, Naprosyn®)
  • Diclofenac (Voltaren®)

NSAIDS may cause side effects. Ask your doctor if they are safe for you to take.

  • Steroid injections into your wrist to decrease pain and inflammation
  • Applying ice or heat to your wrist (your doctor or nurse will tell you which one to use). When using heat:
    • Fill a water bottle with warm, not hot water.
    • Apply it for 20 minutes every 4 to 6 hours.
    • Do not leave heating pads on for more than 20 minutes at a time.
  • When using ice:
    • Apply an ice pack for 20 minutes every 4 to 6 hours.
  • Occupational or physical therapy to:
    • Assist with splintingShow you how to adjust your home and work activities to ease the stress on your wrist
    • Teach you exercises to strengthen your arm, wrist, and hand while you recover