De Quervain's Tenosynovitis

What is De Quervain's Tenosynovitis?

De Quervain’s tenosynovitis (also known as mother's thumb, phone thumb, nintendinitis, etc) is an inflammation of tendons at the base of the thumb. It’s a condition that occurs when two tendons (the extensor pollicis brevis and the abductor pollicis longus) become swollen.

These tendons are cased in sheaths that help to provide a smooth gliding motion for the thumb’s movement. When they become swollen and inflamed, they can put pressure on nearby nerves, causing numbness and pain.

For people suffering from De Quervain’s tenosynovitis, simple actions such as turning the wrist, grasping objects or making a fist become painful. As a consequence, many activities that rely on thumb and wrist movement can no longer be performed without discomfort.

What causes de Quervain’s tenosynovitis?

The most commonly associated cause of De Quervain’s tenosynovitis is the chronic overuse of the wrist. The condition can be brought on by tendonitis in the extensor pollicis longus and abductor pollicis tendons, and made worse by more repetitive motions that further inflame the area.

It’s a particularly common problem for new mothers due to stress placed on the wrist from lifting their baby frequently. Dealing with the condition can be challenging for mothers, as they need to lift their babies as much as 30 times a day.

Other typical causes include daily activities that stress the wrists such as smartphone use, game controllers, housework, carrying and moving heavy items. Some workplace activities that involve heavy strain on the wrists and thumbs can also lead to the development of this condition.

Scar tissue from a previous direct injury to the wrist or rheumatoid arthritis can also cause De Quervain’s tenosynovitis to develop.

Additionally, the condition is more commonly seen in people who are:

  • Female
  • Over 40 years of age
  • Pregnant (due to certain hormonal changes)
  • Of African descent

Symptoms of De Quervain's tenosynovitis

Common symptoms include:

  • Pain and swelling at the base of the thumb
  • Numbness along the index finger and back of the thumb
  • Difficulty performing grasping or pinching movements
  • A sensation of the thumb ‘catching’ or snapping back when moved
  • Tendons making a squeaking sound when moving

How is de Quervain’s tenosynovitis diagnosed?

If you’re experiencing symptoms of this condition, you may want to visit Dr James McLean in one of his convenient orthopaedic surgery practice locations in Adelaide.

During your appointment, Dr McLean will perform a manual examination of your hand while asking you about your symptoms. The appearance of your thumb, the location of your pain and tenderness of the affected wrist will aid Dr McLean’s diagnosis.

Dr McLean will also perform an examination called the Finkelstein manoeuvre. This involves folding the thumb to rest across the palm, then flexing the fingers across the thumb, and moving the wrist downwards towards the little finger.

X-rays may also be required to aid Dr McLean in differentiating De Quervain’s from other diagnoses.

Treatment options for de Quervain's tenosynovitis

What does surgery involve?

The aim of treatment for this condition is to reduce pain and swelling. This can be accomplished by:

  • Applying ice or heat to the affected area
  • Using over-the-counter medications such as Ibuprofen (an anti-inflammatory medication)
  • Resting the wrist and avoiding activities that stress the area
  • Wearing a splint to keep the wrist completely immobilised
  • Steroid injections into the tendon sheath

Certain exercises may be prescribed to help you move in a way that best reduces the stress on your wrist. This can be particularly helpful for new mothers who cannot rest their wrist as they need to lift their baby for breastfeeding, changing and other general care activities.

Many people notice relief of their symptoms after performing one, or a combination of, the above treatments after approximately 4 weeks.

If the above methods fail to relieve symptoms, surgery may be advised to help reduce pressure on the affected tendons.
The goal of surgery is to give the tendons more space so they don’t rub or press on the surrounding area. Surgery involves making a small cut in the roof of the swollen tendons’ sheath to open them up and allow the tendons to glide more freely.

The surgery is done in a hospital operating theatre using minimally invasive methods wherever possible.

Dr McLean is an internationally trained orthopaedic surgeon specialising in minimally-invasive (keyhole) surgery. Dr McLean has a keen interest in the latest technological advancements that allow him to provide patients with improved recovery times.

Dr McLean will recommend a course of action best suited to your individual circumstances, and discuss your treatment and recovery plan prior to your surgery.

Rehabilitation involves exercises to maintain the movement and gliding of your tendons, prevent adhesions from scar tissue; and exercises to strengthen the affected muscles. Patients generally return to normal, pain-free function within 6 weeks.

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