What is DeQuervain’s Tendonitis?

DeQuervain’s tendonitis is a common condition involving the tendons on the thumb-side of the wrist. The syndrome is named after Fritz de Quervain, a Swiss physician who described the condition in the late 1800s. Symptoms arise when there is swelling of the tendons of the thumb/wrist. Instead of gliding smoothly, the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons can rub against the sheath within the wrist. Over time, this area may become irritated and painful. Certain movements of the thumb and wrist can be excruciating. Patients may feel a tender bump or notice swelling in the wrist where the tendons and sheath are thickened. Lifting objects, gripping, or pinching with the thumb often exacerbates symptoms.

The cause of DeQuervain’s syndrome is usually unknown, but symptoms can be aggravated by starting a new, repetitive activity. The condition is common in young females, especially pregnant and post-partum women. Lifting a young child can be very painful making it hard to care for the newborn.

How do I know if I have DeQuervain’s?

DeQuervain’s can be diagnosed by history and physical exam in the office.  An x-ray can sometimes be helpful to rule-out other conditions, such as arthritis or wrist fracture, but this is not required in many cases. Finkelstein’s test can help confirm the diagnosis. During this exam test, the patient places their thumb into their palm and wraps/clasps their fingers around the thumb. The patient then moves their wrist in the direction towards their small finger, reproducing their pain (be careful, this can be excruciating!).

What are the treatment options?

Most people improve with time and do not need surgery. Non-operative treatment is tried first for most patients. Treatment is aimed at reducing pain and improving function. Wearing a splint which supports the thumb can help. Off-the-shelf and custom-made braces are available. Resting the hand by avoiding repetitive thumb motion and forceful gripping may reduce the irritation of the tendons. Anti-inflammatory medications can reduce pain. Hand therapists can teach stretching exercises, make custom splints, and reduce pain with treatments such as iontophoresis (anti-inflammatory medicine delivered through the skin).

Corticosteroid injections (“cortisone shots”) are very effective in relieving symptoms. One or two cortisone shots can make the condition go away completely. Multiple injections should be avoided as they can cause weakening or thining of the skin and soft tissues over time.

If non-operative treament is not effective, surgery may be recommended. DeQuervain’s release surgery is performed to improve the gliding of the tendons with the goal of reducing pain and improving function. During this outpatient procedure, the tight sheath (extensor retinaculum) is opened through a small incision on the thumb-side of the wrist. This can be performed under local anesthesia with or without sedation.

If you would like to be treated for your DeQuervains wrist pain and tendonitis, please call the Raleigh Hand Center to be evaluated by a hand and upper extremity specialist. 919-872-3171