De Quervain's tenosynovitis occurs when the two tendons responsible for thumb extension become inflamed and irritated within the tendon sheath. The swelling causes pain over the thumb side of the wrist and the base of the thumb, especially during certain hand motions, like making a fist, rotating the wrist, and grabbing objects. If caught early, de Quervain's tenosynovititis can usually be treated with non-invasive methods like immobilization, nonsteroidal anti-inflammatory drugs (NSAIDS), and avoiding irritating movements. In some cases, surgery may be required.
Immobilization
Wrist immobilization is one of the treatments for de Quervain's tenosynovitis. According to "Ramamurti's Orthopaedics in Primary Care," immobilization of the wrist and thumb rests the inflamed tendons, giving them a chance to heal. Either a splint or brace is used, to keep the wrist in a neutral position. According to the Body Tuning & Physical Therapy of Carnegie Hall website, the immobilization device typically takes 6 to 8 weeks to be effective.
Physical Therapy
De Quervain's tenosynovitis is also commonly treated by physical therapy. The goal of physical therapy sessions are to minimize inflammation, pain, and promote tendon healing. Modalities such as electrical stimulation are often used, as is manual therapy of the wrist and hand. A physical therapist will educate patients on which repetitive hand movements to avoid in the future, so the condition is less likely to recur.
Medications
NSAIDS are used in conservative treatment of de Quervain's tenosynovitis. Taken as prescribed, these over-the-counter drugs help reduce inflammation and pain. Steroids injections into the affected compartment of the wrist are also commonly used by physicians to treat de Quervain's. According to a study in the "Journal of Bone and Joint Surgery," steroid injections when combined with immobilization resulted in a satisfactory outcome for over half the patients.
Surgery
According to the Cedar Hand Surgery Center, surgery for de Quervain's tenosynovitis is performed when more conservative measures fail to relieve the symptoms. During this out-patient procedure, the doctor will make an incision into the sheath where the affected tendons are located, thus releasing the tendons and relieving pressure. A splint is typically worn afterward for up to 4 weeks.
References
- Mayo Clinic: De Quervain's Tenosynovitis
- Body Tuning Physical Therapy: De Quervain's Tenosynovitis
- "Journal of Bone and Joint Surgery": Treatment of De Quervain Tenosynovitis
- Cedar Valley Hand Surgery: De Quervain's Disease
- "Ramamurti's Orthopaedics in Primary Care" edited by Steinburg, Akins, and Baran, 1992
