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What is de Quervain's tenosynovitis?
Quervain's (say "duh-kair-VANZ") tenosynovitis, also called De Quervain's, is a problem that makes the bottom of
your thumb and the side of your wrist hurt. When you have
de Quervain's, the ropey fiber (tendon) that helps move your thumb away from your
fingers becomes swollen. See a picture of
What causes de Quervain's?
People can get de Quervain's when they
hurt or use the thumb or wrist too much. Common activities that need your wrist
and thumb can cause the problem. Some activities that might cause de Quervain's
If you are pregnant or if you have
rheumatoid arthritis, you are more likely to get de
Quervain's. More women than men have de Quervain's. You can get
the disease at any age. Most people who have de Quervain's are women
between the ages of 30 and 50.
What are the symptoms?
De Quervain's may cause pain when you
twist your wrist. You might also have pain if you grab something between your
thumb and finger. Many people hear a funny sound like a squeak, crackle, snap,
or creak when they move the wrist or thumb.
The bottom of the
thumb or the side of the wrist might also be sore or swollen. This can make it
hard to move your thumb or wrist. The back of the thumb and index finger may
also feel numb. Sometimes de Quervain's can cause a
small bump on the thumb side of the wrist. If you don't get
treatment, the pain can spread up your forearm or down into your thumb.
How is de Quervain's diagnosed?
Your doctor will check for swelling, tenderness, or numbness around the base of the thumb. There may also be crackling or popping when you move your thumb.
doctor may or may not use the Finkelstein test to help diagnose de Quervain's. To do this test, make a fist with your thumb inside. Then bend your
wrist outward toward your little finger. If you feel pain on the thumb side of
your wrist, then you most likely have de Quervain's.
Finkelstein test is done to make sure that you do not have a different problem,
such as arthritis in the bottom of your thumb or
intersection syndrome. Both of these problems affect
the same area of the hand and wrist as de Quervain's.
How is it treated?
The goal of treatment for
de Quervain's is to relieve the pain and swelling in your thumb and
wrist, and restore normal function. Try the following steps to help your
Symptoms often get better in a few weeks with home care. Your doctor may want you to start some gentle stretching exercises once your symptoms are gone.
But if your wrist or thumb still hurts, your doctor might give you a
corticosteroid shot, also called a steroid shot. A
medicine called steroid is injected into your wrist area and the bottom of your
Within 3 weeks of having a steroid shot, most people can
use the wrist and thumb again for normal activities. Few good studies have been done, but in one small study everyone who had a corticosteroid injection had no symptoms 6 days later. People who were using a splint still had some symptoms after 6 days.1 Most people feel better after just one shot, but you might
need another shot after 4 to 6 weeks if your wrist and thumb still hurt. No
more than 3 shots are used.
If your wrist and thumb do not feel
better after trying home treatment and getting 3 shots, your doctor might talk
to you about surgery. After surgery it might take several months for your wrist
to feel completely better. You may need to see a physical or occupational
therapist to help you learn how to use your wrist differently. Then you can go
back to your normal activities. Talk to your doctor about the side effects you
may have from steroid shots or surgery for de Quervain's.
The American Academy of Orthopaedic Surgeons (AAOS)
provides information and education to raise the public's awareness of
musculoskeletal conditions, with an emphasis on preventive measures. The AAOS
website contains information on orthopedic conditions and treatments, injury
prevention, and wellness and exercise.
The mission of the American Society for Surgery of the Hand (ASSH) is to advance the science and practice of hand surgery through education, research, and advocacy on behalf of patients and practitioners. Founded in 1946, the American Society for Surgery of the Hand is the oldest medical specialty society in the United States devoted entirely to continuing medical education related to hand surgery.
Peters-Veluthamaningal C, et al. (2009). Corticosteroid injection for de Quervain's tenosynovitis. Cochrane Database of Systematic Reviews (3).
Other Works Consulted
American Academy of Orthopaedic Surgeons and American Academy of Pediatrics (2010). De Quervain tenosynovitis. In JF Sarwark, ed., Essentials of Musculoskeletal Care, 4th ed., pp. 443–444. Rosemont, IL: American Academy of Orthopaedic Surgeons.
Bednar MS, Light TR (2006). Hand surgery. In HB Skinner, ed., Current Diagnosis and Treatment in Orthopedics, 4th ed., pp. 535–596. New York: McGraw-Hill.
O'Neill CJ (2008). De Quervain tenosynovitis. In WR Frontera et al., eds., Essentials of Physical Medicine and Rehabilitation, 2nd ed., pp. 129–132. Philadelphia: Saunders Elsevier.
Swigart CR (2009). Hand and wrist pain. In GS Firestein, et al., eds., Kelley's Textbook of Rheumatology, 8th ed., vol. 1, p. 658. Philadelphia: Elsevier Saunders.
November 30, 2012
William H. Blahd, Jr., MD, FACEP - Emergency Medicine & Herbert von Schroeder, MD, MSc, FRCSC - Hand and Microvascular Surgery
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