What is DeQuervain’s tenosynovitis?
DeQuervain’s tenosynovitis causes severe pain and localised swelling of the tendons at the wrist that move the thumb. The pain is located on the bone on the radial side (thumb side) of the wrist. It causes exquisite tenderness and pain. DeQuervain’s tenosynovitis normally occurs for no apparent reason but is common during pregnancy and the first year following childbirth and in those that carry out repetitive manual work and excessive computer work. It is diagnosed on ultrasound scan and using a clinical test called Finkelstein’s test.
First line of treatment is rest from painful movements, painkillers/anti-inflammatories and a thumb spica. Physiotherapy can also be useful if it is not too painful. If your pain continues, we would advise a diagnostic ultrasound scan (you do not need an MRI scan) to confirm the diagnosis and discover why it is not improving. If other more conservative measures do not help, an ultrasound guided steroid injection is a very effective treatment for DeQuervain’s tenosynovitis. Steroid injections carried out under ultrasound guidance are well supported in the medical literature and should be considered if your pain is not improving. They normally provide rapid pain relief.
What are the symptoms of DeQuervain’s tenosynovitis?
The symptoms of DeQuervain’s tenosynovitis are:
- Pain, tenderness and swelling on the thumb side of the wrist
- Pain with all thumb movements
- Point tenderness on the bone on the radial side (thumb side) of the wrist
If this sounds like your pain, read on below…
What other conditions can mimic DeQuervain’s tenosynovitis?
If this does not sound like your pain, there are other conditions that can mimic the pain of DeQuervain’s tenosynovitis such as:
- Osteoarthritis of the wrist
- Carpal tunnel syndrome
- Osteoarthritis of the thumb
- Triangular fibrocartilage complex (TFCC) tear
- Scapholunate ligament injury
DeQuervain’s tenosynovitis vs osteoarthritis (OA) of the thumb
The location of the pain is one of the key differences between DeQuervain’s tenosynovitis versus osteoarthritis of the thumb. DeQuervain’s tenosynovitis causes very localised pain and tenderness specifically on the radial (thumb) side of the wrist and is predominantly aggravated by thumb movements. Whereas OA thumb causes more diffuse pain, stiffness, and swelling near the base of the thumb. DeQuervain’s disease is more common in younger men and women, particularly women immediately postpartum, whereas thumb osteoarthritis is more common in those over 50 years old.
The anatomy
De Quervain’s tenosynovitis is a very painful condition affecting two tendons of the thumb. These tendons are the extensor pollicis brevis tendon (EBP) and abductor pollicis longus tendon (APL). These tendons run along the outer side of the wrist (you can see them yourself. They are the strong rope like structures that appear when you stick your thumb up!). These tendons are surrounded to a protective, friction reducing sheath which is in turn is held in place by a structure called the extensor retinaculum. This mechanism allows the tendons to stay in place and freely move when using your thumb during movements such as using your phone or typing.
How does De Quervain’s tenosynovitis happen?
De Quervain’s tenosynovitis is typically an over use injury caused by repetitive movements of the thumb (Carlton et al., 2002). It happens when the EPB and APL tendons are subjected to repetitive movements of the thumb or after a period of increase in activity. This could be after increased typing, starting a new sport involving gripping or caring for a new born baby.
How do we diagnose De Quervain’s tenosynovitis?
When you attend an assessment at Complete injections one of our clinicians will fully assess your condition before discussing the most appropriate treatment option for you. All our experts are extended scope physiotherapy practitioners who are fully qualified musculoskeletal Sonographers and have extensive experience in assessing and treating De Quervain’s tenosynovitis. Your assessment starts with a discussion aimed at understanding how, why and when your symptoms started. You will also be asked questions about your medical history. This is to rule out other medical conditions such as Rheumatoid arthritis that may masquerade as De Quervain’s tenosynovitis.
A series of clinical (physical) tests will then be used to hone done on the structures causing your pain (Peters-Veluthamaningal et al., 2009). Once our clinician has formulated a working diagnosis a formal diagnostic ultrasound scan will be completed. This allows us to look under the skin to actually see what is causing your pain.
A diagnostic ultrasound scan has been proven to be highly specific at identifying De Quervain’s tenosynovitis. Diagnostic ultrasound able to visualise specific local inflammation around the tendons of the thumb. The quality of the thumb tendons can also be easily observed and accessed for signs of tendinopathy (tendon damage) or tear. The information gained from combining clinical testing and diagnostic ultrasound results in a highly accurate diagnosis and therefore, the most appropriate treatment plan can be selected.
When assessing for De Quervain’s tenosynovitis we also ensure other pathologies around the wrist and hand are reviewed and ruled out as causative of your pain. Other hand and wrist conditions that can present as De Quervain’s tenosynovitis include:
How do we treat De Quervain’s tenosynovitis?
Treating De Quervain’s tenosynovitis can be lengthy and difficult process. We use our hands constantly whether to complete activities of daily living or during recreational tasks such as sports, computer gaming or even during creative past times such as painting. Due to our reliance on using our thumb De Quervain’s tenosynovitis symptoms can remain an issue for many months even years. Many patients report intermittent periods of rest and flares of increased pain.
It is recommended that all patients trial conservative physiotherapy before undertaking an ultrasound guided steroid injection. Initial treatment is overseen by a physiotherapist and often include techniques such as;
- Activity modification advice (to help you avoid flare ups).
- Upper limb postural correction including ergonomic changes for your working environment.
- Pain management techniques (Ice advice when suffering a pain flare).
- The provision of a brace to hold your thumb in a safe position during the night or when undertaking tasks that can increase your pain, such as lifting and carrying heavy or awkward objects (see below image) (Peters-Veluthamaningal et al., 2009)
- Thumb and forearm strengthening exercises.
- Thumb and forearm stretching advice.
What options do I have if conservative management doesn’t work?
Don’t worry if physiotherapy has not been effective for your condition. There is a quick and effective option still available to you. Steroid injections have been shown to be a highly effective treatment for De Quervain’s tenosynovitis. During an ultrasound guided injection your clinician will be able to deposit a small amount of anti-inflammatory medication (known as a corticosteroid) and a local anaesthetic (short acting numbing agent) directly to the target tissue. This is only made possible due to the high accuracy rates of this technique. All our injections are completed under ultrasound guidance by a highly experienced sonographer who is fully qualified to prescribe the most effective medication of you so there is no need to get a referral or prescription from you G.P. you can self refer directly into our service.
An ultrasound guided steroid injection for De Quervain’s tenosynovitis is usually very comfortable and well tolerated. Following the injection, the majority of patients will experience a significant reduction in their symptoms within just a few days, however, a steroid injection is not a silver bullet for this condition. It is vitally important that an injection is followed by a period of physiotherapy rehabilitation. As symptoms begin to settle then rehabilitation of the wrist and hand can start. Your treating clinician will be able to provide you with tailored guidance for ongoing treatment.
It is well known that De Quervain’s tenosynovitis is common during pregnancy and in mothers of small children. Please note that we do not offer injections for patients during pregnancy as the potential risks of transferring the steroid medication to the infant are unknown. However, we do offer injections to patients who are breastfeeding as the British breastfeeding Association has confirmed that low dose steroid injections do not present a risk to the breastfeeding baby.
If you have been diagnosed with De Quervain’s tenosynovitis or you think you might be suffering from this condition please contact us on injections@complete-physio.co.uk or call us on 02074823875 . We can arrange a telephone call from one of our highly experienced clinicians to help you decide on best course of treatment.
Other Wrist & Hand conditions:
- Osteoarthritis (OA) wrist joint
- Trigger Finger/thumb
- Carpal Tunnel Syndrome
- Osteoarthritis of the thumb
- Triangular fibrocartilage complex (TFCC)
- Scapholunate ligament injury (pain in the wrist)
Research Articles of Interest
McDermott, J.D., Ilyas, A.M., Nazarian, L.N. and Leinberry, C.F., 2012. Ultrasound-guided injections for de Quervain’s tenosynovitis. Clinical Orthopaedics and Related Research®, 470(7), pp.1925-1931.