de Quervain syndrome

de Quervain syndrome (also known as washerwoman's sprain, Radial styloid tenosynovitis, de Quervain disease, de Quervain's tenosynovitis, de Quervain's stenosing tenosynovitis or mother's wrist), is an inflammation or a tendinosis of the sheath or tunnel that surrounds two tendons that control movement of the thumb.
It is name for named for Swiss surgeon Fritz de Quervain who first identified it in 1895. It should not be confused with "de Quervain's thyroiditis", another condition named for the same person.
Working in the garden, playing music, knitting, cooking and walking your pet can all be enjoyable activities, but if these activities cause pain in your wrist and hand, you may have a condition known as de Quervain's tenosynovitis.
In de Quervain's tenosynovitis, the sheath of the tendons on the thumb side of your wrist becomes inflamed or swollen, restricting the tendons' movement. The result with de Quervain's tenosynovitis is discomfort and pain every time you turn your wrist, grasp anything or make a fist.

Treatment for de Quervain's tenosynovitis may range from immobilizing your wrist and taking medications to surgery in more serious cases. If you start treatment early on, your symptoms of de Quervain's tenosynovitis should generally improve within four to six weeks.

Causes:

When you grip, grasp, clench, pinch or wring anything in your hand, you use two major tendons in your wrist and lower thumb. These tendons run side by side from your forearm through the thumb side of your wrist. They normally glide unhampered through the small tunnel that connects them to the base of the thumb. In de Quervain's tenosynovitis, the tendons' slippery covering becomes inflamed, restricting movement of the tendons.

A common cause is chronic overuse of your wrist. For example, peeling carrots involves a repetitive motion, a bent wrist and the gripping of the peeler. If you peel carrots or potatoes day after day, hour after hour, this combination may be enough to irritate the sheath around the two tendons.

Other causes of de Quervain's tenosynovitis include:
* Direct injury to your wrist or tendon; scar tissue can restrict movement of the tendons.
* Inflammatory arthritis, such as rheumatoid arthritis.

Symptoms:

The main signs and symptoms of de Quervain's tenosynovitis are pain and swelling near the base of your thumb. The pain may appear suddenly or may increase over time. If the condition goes too long without treatment, the pain may spread farther into your thumb, back into your forearm or both.
Pinching, grasping and other movements of your thumb and wrist aggravate the pain.

Symptoms of de Quervain's tenosynovitis include:
* Pain near the base of your thumb.
* Swelling near the base of your thumb.
* Numbness in the back of your thumb and index finger, caused by the swollen tendon rubbing on a nerve.
* A fluid-filled cyst in the same region as the swelling and pain.
* Difficulty moving your thumb and wrist when you're doing activities that involve grasping or pinching.
* A "sticking" or "stop-and-go" sensation in your thumb when trying to move it.
* A squeaking sound as the tendons try to move back and forth through the inflamed sheaths.

Diagnosis:

Your doctor may confirm a diagnosis of de Quervain's tenosynovitis by doing a Finkelstein test. In this simple test, you bend your thumb across the palm of your hand and bend your fingers down over your thumb. Then you bend your wrist toward your little finger. If this causes pain on the thumb side of your wrist, the test is considered positive.

If you feel pain about three inches up your forearm, you may have a condition called intersection syndrome. This is similar to de Quervain's tenosynovitis, but affects a different area of your wrist and requires different treatment.

Treatment:

To reduce pain and swelling, initial treatment of de Quervain's tenosynovitis may include:

* Immobilizing your thumb and wrist, keeping them straight with a splint or brace to help rest your tendons.
* Avoiding repetitive thumb movements whenever possible.
* Avoiding pinching with your thumb when moving your wrist from side to side.
* Applying heat to or icing the affected area.
* Using nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve).

Your doctor may also recommend injections of corticosteroid medications into the tendon sheath to reduce swelling. Treatment is generally successful if begun early on, though overuse injuries often recur if you have difficulty discontinuing the repetitive motions that caused the condition in the first place.

Making adjustments

Your medical team may include a physical therapist or occupational therapist who may monitor your habits and give suggestions on how to make necessary adjustments to relieve stress on your wrists. Your therapist can also teach you exercises focused on your wrist, hand and arm to strengthen your muscles, reduce pain and limit the irritation of the tendons.

In more serious cases

If your case is more serious, your doctor may recommend outpatient surgery. Surgery involves a procedure in which your doctor inspects the sheath surrounding the involved tendon or tendons, and then opens the sheath to release pressure.