Wrist Tendonitis / DeQuervain’s Tenosynovitis

What is De Quervain Tenosynovitis?

Wrist tendonitis, or de Quervain’s tenosynovitis, is a condition that causes the tendons along the thumb side of the wrist to the base of the thumb to swell. The condition is brought up by constriction of the tendons by the sheath they go through to get to the hand from the wrist. De Quervain’s tenosynovitis causes pain and tenderness along the thumb. This pain can be felt when you:

• Form a fist
• Turn the wrist
• Grasp something
• Move the thumb
• Lift something with the thumbs pointed upwards

If you experience sensitivity or pain when you make any of these motions, or you feel a lump on wrist tendon, contact us at Sforzo|Dillingham|Stewart Orthopedics + Sports Medicine for diagnosis and treatment. We have a team of experienced doctors who will perform tests, give you a diagnosis, and guide you toward the journey of good health. This article highlights more on symptoms, causes, diagnosis, and treatment for de Quervain’s Tenosynovitis.

What are the Symptoms of DeQuervain’s Tenosynovitis?

When you feel tenderness or pain in your thumb, the first thought is likely to be that it is a passing pain or an ice pack or over-the-counter medicine will treat it. However, if the pain does not subside and performing tasks requiring grasping items becomes challenging, it indicates that you need to see a doctor. Dr. Sforzo recommends you visit our clinic should you experience the following wrist tendonitis symptoms;

• Pain along the base of the thumb or thumb side of the wrist
• A sticking sensation when you move the thumb or wrist
• Difficulties when pinching or gripping something 
• Feeling a popping sensation in my wrist when you move the thumb
• Unyielding pain as you use the wrist or thumb

What Causes DeQuervain’s Tenosynovitis?

Although medical practitioners do not know the exact cause of de Quervain tenosynovitis, some conditions lead to the development of this condition. 

• Inflammatory arthritis

Inflammatory arthritis is a category of arthritis accompanied by swelling, joint pain, tenderness, warmth, and morning stiffness. Rheumatoid arthritis is an excellent example of inflammatory arthritis. This illness affects your tendons, ligaments, bone, and cartilage. 

• Direct Injury 

If you fall on your hands or hurt the wrist, there is a high chance that the tendons from your wrist to the thumb will be affected. Such a direct injury can cause a lot of damage, leading to wrist tendonitis.

• Fluid Retention

The lymphatic system, kidneys, hormonal factors, and circulatory system all work together to maintain the body’s fluid levels. If one of these systems faces any problem, the entire body will be in jeopardy, and fluid retention will happen. Also known as edema, fluid retention can be caused by 

• Obesity
• Physical inactivity
• Congestive heart failure
• Pregnancy due to hormonal changes
• Capillary damage
• Kidney failure
• Malnutrition
• Hormonal imbalance
• Infections and allergies
• Medicine

Risk Factors of Wrist Tendonitis

Although the exact cause of tendonitis in wrists is not yet known, there are risk factors that can increase one’s likelihood of suffering from wrist tendonitis. However, these risk factors are different from one person.  

• Age

As tendons age, their tolerance to stress and their elasticity decrease. Also, the wear and tear that the tendons have been subjected to over the years catch up with them, and once you hit the 40-year mark, the chances of getting de Quervain’s tenosynovitis go up. 

• Sex

The likelihood of a woman getting wrist de Quervain’s tenosynovitis is higher than in men. A woman’s body experiences many hormonal changes due to pregnancy and menstruation. As a result, hormonal changes or imbalance makes the body prone to fluid retention, which is a cause of the illness. 

• Pregnancy

During pregnancy, the body goes through various hormonal changes. Although some hormonal changes are more severe than others, any slight change in hormones can cause edema. 

Pregnant mothers who stand for long periods and are in areas with hot climates also tend to hold more water than those in cool regions or don’t spend a lot of time standing. Fluid retention leads to swelling of body parts and can easily cause de Quervain’s tenosynovitis. 

• Baby Care

When carrying a baby, you have to position your hand so that the thumbs are pointing up. This constant motion stresses the tendons in your hands. Doing this consistently can cause the tendons to tear and swell, hence de Quervain’s illness. 

• Metabolic Disorders

Metabolic disorders such as obesity, hypercholesterolemia, increased uric acid in the blood, diabetes, and other metabolism disorders lead to tendon degeneration. When tendons degenerate, their mechanical properties are affected, leading to illnesses like de Quervain’s tenosynovitis. 

If you are suffering from any of these conditions and it is left untreated, it will interfere with the healing process of tendonitis even after surgery. Therefore, if one is to deal with wrist tendonitis, you should also address these metabolic disorders. 

• Genetic Disorders

Genetic disorders such as Ehlers-Danlos syndrome can cause de Quervain’s tenosynovitis. One of the most common categories of this disorder is the hypermobility type that affects the connective tissues, tendons, blood vessels, and joints. 

A study on Genetic Marker Associated with De Quervain’s Tenosynovitis revealed that there is a genome-wide significant association with de Quervain’s tenosynovitis.

Jobs and Hobbies that Require Repetitive Hand Motion

When you pinch, wring, grasp, or grip anything in your hand, the tendons on the lower thumbs and the wrist glide through a tunnel that connects them at the base of the thumb. This gliding process is usually smooth with no friction. 

However, if you make these motions repeatedly, the sheath around these two tendons will be irritated. The irritation causes swelling and thickening, which makes this movement challenging. 

When to see a Doctor

When you get a mild injury or swelling, there is always that period where you wait it out to see if it will turn out to be something serious or if the swelling will go down by itself. During this waiting period, our doctors recommend you to try the following:

• Not using the thumb
• Over the counter medicine
• Putting ice on the wrist or thumb

If the three do not work, then it is an indication that you need to contact our doctors for further assistance. Waiting for long periods can lead to complications, and at the end of the day, you might have to undergo surgery for a condition that could have been avoided. 

How to Diagnose and Treat De Quervain’s Tenosynovitis

If a patient visits Sforzo|Dillingham|Stewart Orthopedics + Sports Medicine clinic with any of de Quervain’s illness’ symptoms, Dr. Sforzo will first conduct a test known as Finkelstein test for proper diagnosis. For this test, you will make a fist and wrap your fingers over the thumb. 

The wrist moves up and down by keeping my hand in this position. This test pulls the tendon through the narrow sheath. If you experience any pain, there is a higher chance that you have de Quervain’s tenosynovitis.  

Dr. Sforzo can use surgical or non-surgical treatment methods depending on the diagnosis. The non-surgical procedures include

• Wearing splints for about six weeks
• Wrist tendonitis exercises
• Using an ice pack on the thumb to reduce swelling
• Keeping off activities that cause swelling and pain
• Administering over-the-counter medicine such as anti-inflammatory, pain relievers
• Steroids. If other treatment options are not working, corticosteroid injections will be administered to relieve pain. One injection can keep off the pain for several weeks.

If the non-surgical approach does not work, Dr. Sforzo will have to recommend surgical treatments. The surgery is normally outpatient and can be carried out with mild sedation or under local anesthesia. 

During the surgery, the doctor will make a small incision in the sheath where the tendon passes. This action will allow the tendons to glide easily through the sheath. 

This surgery will get rid of pain and swelling. It will also restore the original motion of the thumb and wrist. 

After surgery and recovery, Dr. Sforzo will recommend an exercise program to restore the thumb and wrist strength. Different patients will recover under a different time frame depending on age, the length of the symptoms before treatment, and general health. 

If the illness developed slowly, your recovery time would be slower than that of a patient who saw a doctor after a sudden onset of the symptoms.  

Prevention of De Quervain’s Tenosynovitis

Although there are factors causing de Quervain’s tenosynovitis that are beyond your control, such as hormonal imbalance, accidents, and arthritis, there are measures you can take to prevent the illness. You have to look at actions that involve repetitive hand motions. You should avoid stressing your tendons by reducing these activities, taking breaks, or avoiding them altogether.

Anytime you feel a certain motion is causing pain in your wrist or thumb, you should stop doing it and find an alternative. In case of injuries on the wrist and thumb, you ought to see one of our doctors immediately instead of self-medicating.

After treatment, you should follow the doctor’s advice and take medicine as prescribed. These actions cannot fully protect you from de Quervain’s tenosynovitis but will lower the risks of the illness. 

Outlook for De Quervain’s Tenosynovitis

Usually, de Quervain’s tenosynovitis reacts well as expected to treatment. In most cases, patients do not need surgery as non-surgical methods such as cold press, braces, and anti-inflammatory medicine, and injections work well. 

Surgery cases have a high success rate and few complications since the surgery is not complex. If wrist tendonitis is left untreated, it can become severe and affect one’s ability to carry out simple daily tasks. 

De Quervain’s tenosynovitis is usually a mild condition that can be easily treated without surgery. If you experience more than one tendonitis wrist symptom, you should seek medical help instead of letting the symptoms progress. Contact Sforzo|Dillingham|Stewart Orthopedics + Sports Medicine  at (941) 378-5100 to set an appointment with Dr. Sforzo, who specializes in wrist injuries. We have a team of qualified and skilled surgeons specializing in shoulder, elbow, spine, wrist, hands, knees, foot and ankle, and hips and thigh injuries. Our doctors use surgical and non-surgical treatment techniques depending on the diagnosis of our patients.