De Quervain’s Syndrome: Causes, Symptoms, and Treatment

De Quervain’s syndrome is a painful condition that affects the tendons at the base of the thumb, specifically those passing through a narrow tunnel in the wrist. This condition is primarily associated with repetitive movements of the wrist and thumb, leading to inflammation and, at times, thickening of the tendons that control thumb movement. It is classified as a type of tendinopathy or tenosynovitis.

Anatomy Affected

De Quervain’s syndrome primarily affects two tendons:

The abductor pollicis longus (which moves the thumb outward and away from the palm).
The extensor pollicis brevis (which extends the thumb).

Both tendons pass through a synovial sheath that acts as a "guide" for their movement. The problem occurs when this sheath becomes inflamed, creating pressure on the tendons, causing pain and impairing normal thumb movement.

Causes of De Quervain’s Syndrome

The exact causes of De Quervain’s syndrome are not always clear, but several factors can contribute to its development:

Repetitive Movements: The most common cause is repetitive activity involving the wrist and thumb. People who perform gripping actions, such as typing, using a computer mouse, gardening, or playing sports like tennis, may be at greater risk.

Previous Injuries: A trauma or injury to the wrist, such as a sprain or fracture, can increase the likelihood of developing this condition.

Pregnancy: Pregnant women, particularly in the third trimester, have an increased risk due to hormonal changes and fluid retention that may affect the tendons.

Anatomical Factors: Some individuals may naturally have a narrower anatomical tunnel in the wrist, which can cause greater compression of the tendons and make them more susceptible to inflammation.

Occupational or Sports Factors: Those who perform activities that require frequent or prolonged use of the hands and wrists in fixed positions or repetitive motions—such as working on an assembly line, sewing, playing musical instruments, or engaging in sports that involve extensive use of the wrist and thumb (e.g., tennis or golf)—are more likely to develop this syndrome.

Symptoms of De Quervain’s Syndrome

Symptoms can vary in intensity, but typically include:

Pain at the Base of the Thumb: The pain usually begins at the outside of the wrist near the base of the thumb. It may radiate up the forearm or down the wrist.

Swelling: In some cases, the affected area may swell due to the inflammation of the tendons and the synovial sheath.

Difficulty Moving the Thumb: Pain and stiffness may make it difficult to perform everyday tasks, such as gripping objects or turning a key. The pain may worsen with repetitive motions or certain actions like writing or holding onto items.

Tenderness at the Wrist: Pressing on the base of the thumb, especially over the affected tendon, may result in sharp pain.

Clicking or Snapping Sensation: Some individuals may feel or hear a "snap" or "click" when moving the thumb due to friction between the inflamed tendons.

Diagnosis

The diagnosis of De Quervain’s syndrome is primarily based on the patient’s medical history, physical examination, and provocative tests. One common test is the Finkelstein test, where the patient is asked to make a fist with the thumb tucked inside the fingers and then tilt the wrist toward the little finger. If this movement causes sharp pain at the base of the thumb, De Quervain’s syndrome is highly suspected.

In some cases, the doctor may order X-rays to rule out other conditions like fractures or arthritis. Ultrasound or MRI may also be used to visualize the inflammation and the condition of the tendons.

Treatment of De Quervain’s Syndrome

Treatment for De Quervain’s syndrome focuses on reducing inflammation and relieving pain. Options include:

1. Rest and Activity Modification

Avoiding activities that worsen the pain and reducing repetitive wrist and thumb motions is crucial for recovery. In some cases, a splint or brace may be used to immobilize the wrist and thumb.

2. Anti-inflammatory Medications

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can help reduce inflammation and alleviate pain.

3. Physical Therapy

Physical therapy may include stretching and strengthening exercises for the tendons and muscles of the wrist and thumb, which helps improve range of motion and reduce pressure on the inflamed tendons.

4. Corticosteroid Injections

If conservative treatments do not provide relief, the doctor may recommend corticosteroid injections to reduce tendon inflammation. These injections can provide temporary relief, but are not a long-term solution.

5. Surgery

In rare cases, if symptoms persist despite conservative treatment, surgery may be considered to release the tendons from pressure within the synovial sheath. The surgery typically involves a small incision to cut open the inflamed sheath and relieve tension on the tendons.

Prevention

Some measures that can help prevent De Quervain’s syndrome include:

Take frequent breaks during repetitive activities to rest the hands and wrists.
Stretch and strengthen the muscles of the wrist and thumb.
Maintain proper posture while typing or performing other tasks to avoid awkward wrist positions for prolonged periods.
Use ergonomic tools that minimize strain on the hands and wrists.

Conclusion

De Quervain’s syndrome is a condition that can significantly limit daily activities due to pain and stiffness at the base of the thumb. Fortunately, with early diagnosis and appropriate treatment, most individuals recover without the need for surgery. The key is to identify the symptoms early, modify the activities that contribute to the condition, and follow the healthcare provider’s recommendations for successful recovery.