de Quervain Tendonitis
Radial styloid tenosynovitis, more commonly known as de Quervain tendonitis or syndrome, is an inflammatory condition affecting the tendons that straighten the thumb. The name comes from a Swiss surgeon, Fritz de Quevain, who first described the condition in the early 1900s.
Region of pain experienced with de Quervain syndrome
Symptoms
Patients with de Quervain syndrome have pain along the radial side (thumb side) of the wrist during grasping, twisting or thumb motions. The region is often tender when pressed upon, and oftentimes noticeably swollen.
Cause
The cause is unknown, but may be due to overuse or minor trauma to the tendons of the thumb. The tendons to the thumb pass through a narrow tunnel alongside the wrist, and when the tendons are irritated or inflamed, they glide less smoothly and comfortably. Other names given to the condition include “texting thumb” and “Nintendinitis”, highlighting the link between overuse of the thumb and symptoms. It is known to be more common in women, and oftentimes seen during and after pregnancy due to overuse, hormones, or fluid changes.
De Quervain tendonitis is caused by swelling of the tendons that extend the thumb. This prevents them from smoothly gliding through their tunnel (top image).
If the swelling does not improve with conservative treatment, the roof of the tunnel can be released to allow for smooth and comfortable tendon gliding (bottom image).
Thumb spica splint
Non-Surgical Treatment
Thumb spica splint - this limit thumb and wrist motion, which allows the tendons to rest, thereby decreasing inflammation
Anti-inflammatories - (such as ibuprofen or naproxen – if medically safe)
Steroid injection - the most effective non-surgical way of decreasing pain and eliminating symptoms. A cortisone injection into the tunnel bathes the tendons in a strong anti-inflammatory fluid. This shrinks the inflamed tendons, and can restore normal, pain-free tendon gliding.
Surgical Treatment
If non-operative solutions fail, surgery may occasionally be warranted. This involves dividing, or releasing, the roof of the tunnel through which the thumb tendons pass.
This creates more space for the tendons to glide smoothly, resulting in prompt improvement of the tendonitis pain.
This is a quick, outpatient procedure done through a small incision (<1 inch) over the wrist.
Absorbable sutures are placed underneath the skin, and Dermabond (medical grade "Super Glue") is used to seal the incision. A bandage is placed which remains in place for 3 days.
The hand can be used for normal light activities immediately, and you can get the incision wet once the bandage is removed. More demanding activities (e.g. lifting weights, gardening, manual labor) should be avoided until the skin heals (~10 days).
“I was diagnosed with De Quervain’s tendinitis. I went to see Dr. Schreiber. He was was very nice and knowledgeable. We tried a cortisone shot but ended up having surgery. He explained the issue in a way that I was able to understand. I had immediate relief and the recovery was very easy, just as Dr. Schreiber described it would be! In addition, you can barely see my scar! Had a wonderful experience with Dr. Schreiber and Raleigh Ortho and am happy to be pain free again! Would highly recommend Dr. Schreiber!”
“I developed a pretty severe case of tendinitis in both wrists during my second trimester of pregnancy and was told by another doctor at a different practice that it was carpal tunnel. I was prescribed two hand braces to wear at night that did absolutely nothing except make my condition worse. Each passing day I was in more and more pain and knew in my heart this was getting pretty bad. I would cry because I worried I wouldn’t be able to hold my newborn. I have a very high threshold for pain, so exaggeration isn’t my thing. I truly worried about this. My obgyn suggested I wait six weeks after having my baby to see if the fluids would go away, which would hopefully make the ‘carpal tunnel’ go away as well. My gut was right. It didn’t get any better. As a matter of fact it got worse, which I didn’t think could even be possible. She referred me to Dr. Schreiber and within seconds of telling him my symptoms, he told me I had de quervain’s tenosynovitis. We started with steroid shots but they didn’t do anything. Intervening through surgery was the only option at that point. Here I am now, six weeks postsurgery on my left hand and three weeks postsurgery on my right hand, and I swear I feel like a new person! Sounds crazy but I couldn’t even perform the simplest tasks for the longest time....anything and everything you can imagine. I am amazed that not only can I hold my four month old without being in excruciating pain but I can actually take her places, pain free, without someone having to be with me to help me. I’m forever grateful to Dr. Schreiber because not only is he a very humble and caring physician, he’s nothing short of an amazing surgeon. Plus my scars have healed beautifully. HIGHLY recommended!”
Dr. Schreiber is a board certified orthopedic surgeon specializing in hand, wrist, and elbow conditions. Dr. Schreiber practices at the Raleigh Orthopaedic Clinic in Raleigh, North Carolina.