De Quervain’s Tenosynovitis
De Quervain’s tenosynovitis is the swelling of the tendons that run along the thumb side of the wrist and attach to the base of the thumb.
This occurs when the tendons are constricted by the sheath that they run through to get from the wrist to the hand.
This condition can cause pain and tenderness along the thumb side of the wrist. This is particularly noticeable when you are:
• Moving the thumb
• Forming a fist
• Grasping or gripping something
• Turning the wrist
• Lifting something with your arms in front of you and thumbs pointed toward the ceiling (e.g., lifting a child)
De Quervain’s tenosynovitis affects the abductor pollicis longus (APL) and the extensor pollicis brevis (EPB).
These are two of the main tendons to the thumb that assist with bringing the thumb out away from the index finger (APL) and straightening the joints of the thumb (EPB).
These two tendons arise from muscles in the forearm and then run together in a sheath that keeps them close to the bone as they cross over from the thumb side of the wrist into the hand.
Tendons are rope-like structures that attach muscle to bone, allowing the muscle to pull on and move the bone. Tendons are covered by a slippery and thin soft-tissue layer called synovium.
This layer provides nutrients to the tendons and allows them to slide easily through the sheath that surrounds them.
Any swelling of the tendons and/or thickening of the sheath can result in a situation where the tendons no longer fit well inside the sheath.
This results in increased friction and pain with certain thumb and wrist movements.
Causes
• De Quervain’s tenosynovitis is common and may be caused by overuse of the thumb and wrist.
• It also is associated with pregnancy and breastfeeding.
• People with rheumatoid arthritis may be more susceptible to De Quervain’s tenosynovitis.
• It is most common in people in their 40s and 50s and affects more women than men.
Symptoms
These are signs of De Quervain’s tenosynovitis:
• You may feel pain over the thumb side of the wrist. This is the main symptom. The pain may appear either gradually or suddenly. It starts in the wrist and can travel up the forearm. The pain is usually worse when the hand and thumb are in use. This is especially true when forcefully grasping and/or lifting objects or twisting the wrist.
• You may see swelling over the thumb side of the wrist. This swelling may accompany a fluid-filled cyst in this region. • You may feel a catching or snapping sensation when moving the thumb. • Pain and swelling may make it difficult to move your thumb and wrist.