Symptoms of de Quervain’s tenosynovitis include:
- Pain near the base of your thumb
- Swelling near the base of your thumb
- Difficulty moving your thumb and wrist when you’re doing activities that involve grasping or pinching
- A “sticking” or “stop-and-go” sensation in your thumb when trying to move it
If the condition goes too long without treatment, the pain may spread farther into your thumb, back into your forearm or both. Pinching, grasping and other movements of your thumb and wrist aggravate the pain.
Test and diagnosis
To diagnose de Quervain’s tenosynovitis, Dr. Setty will examine your hand to see if you feel pain when pressure is applied on the thumb side of the wrist.
Dr. Setty will also perform a test called the Finkelstein test. In a Finkelstein test, you bend your thumb across the palm of your hand and bend your fingers down over your thumb. Then you bend your wrist toward your little finger. If this causes pain on the thumb side of your wrist, you likely have de Quervain’s tenosynovitis.
Imaging tests, such as X-rays, generally aren’t needed to diagnose de Quervain’s tenosynovitis.
Treatment for de Quervain’s tenosynovitis may include medications, physical or occupational therapy, or surgery. Treatment is generally successful if begun early on, though the pain may recur if you can’t discontinue the repetitive motions that aggravate your condition. If you start treatment early on, your symptoms of de Quervain’s tenosynovitis should generally improve within four to six weeks. When de Quervain’s tenosynovitis starts during pregnancy, symptoms usually get better around the end of pregnancy or when breast-feeding stops.
To reduce pain and swelling, Dr. Setty may recommend using NSAIDs, such as ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve).
Dr. Setty may also recommend injections of corticosteroid medications into the tendon sheath to reduce swelling. If treatment begins within the first six months of symptoms, most people recover completely after receiving corticosteroid injections, often after just one injection.
Initial treatment of de Quervain’s tenosynovitis may include:
- Immobilizing your thumb and wrist, keeping them straight with a splint or brace to help rest your tendons
- Avoiding repetitive thumb movements whenever possible
- Avoiding pinching with your thumb when moving your wrist from side to side
- Applying ice to the affected area
You may also see a physical or occupational therapist. These therapists may review your habits and give suggestions on how to make necessary adjustments to relieve stress on your wrists. Your therapist can also teach you exercises focused on your wrist, hand and arm to strengthen your muscles, reduce pain, and limit the irritation of the tendons. The therapist may also make a splint to keep your wrist and thumb from moving if off-the-shelf versions don’t fit you well.
If your case is more serious, Dr. Setty may recommend outpatient surgery. Surgery involves a procedure in which your doctor inspects the sheath surrounding the involved tendon or tendons, and then opens the sheath to release the pressure and restore free tendon gliding.
Dr. Setty will talk to you about how to rest, strengthen and rehabilitate your body after surgery. A physical or occupational therapist may meet with you after surgery to teach you new strengthening exercises and help you adjust your daily routine to prevent future problems.