DeQuervain's Syndrome

Do you have pain on the outer side of your wrist during several activities such as cooking, lifting a bag, and playing music? You might have DeQuervain’s syndrome. Also known as De Quervain’s, DeQuervain’s tenosynovitis or washerwoman’s hand or mother’s wrist, it is a condition which affects women more commonly.

Pathology

In DeQuervains syndrome, the covering i.e. sheath of two tendons on the outer side of the thumb becomes inflamed and swollen. The two tendons involved are the extensor pollicis brevis and the abductor pollicis longus. Both these tendons work to move the thumb away from the hand in the same plane as the palm. These two tendons run side by side from the forearm to the thumb and have smooth and unhampered sliding through the sheath. When the sheath becomes inflamed it restricts the movements of the thumb and wrist.

Symptoms

The primary symptom of DeQuervain’s syndrome is pain at the base of the thumb. The pain may be sudden or gradual. If untreated for a prolonged period it may spread further into the thumb or the forearm. Commonly associated with the pain is a swelling localized to the base of the thumb. There is difficulty in moving the thumb and wrist in movements such as gripping, pinching and lifting. Often, a stiff or a stop-and-go sensation can be felt at the thumb with a squeaking sound as the tendons try to move within the sheath.

Causes

DeQuervain’s syndrome is an idiopathic condition, which means no particular known cause is known. It is supposed that the commonest cause of DeQuervain’s syndrome is an overuse of the wrist, e.g. activities that involve frequent lifting, wringing or peeling. Activities that eccentrically load the wrist, i.e. stretch the wrist with load, stresses the wrist a lot more. Examples of eccentric activities that load the wrist include lowering a child or putting a heavy stack of plates down.

DeQuervain’s syndrome is often considered under the spectrum of repetitive stress injury. Occupations that are at a risk are office workers, musicians, carpenters. New mothers are at a particular risk of developing this syndrome because of the movement of frequent lifting of the baby. Other causes can be a direct injury to the wrist or rheumatoid arthritis.

Test and Diagnosis

A common test used by doctors to diagnose DeQuervain’s syndrome is Finkelstein’s test. This simple test can be done on one’s self to confirm DeQuervain’s. Place the thumb in a bent position across the palm and then hold it with your fingers bending down over it. Move the wrist towards the little finger. If this causes pain on the thumb side of the wrist then the test is considered positive.

Treatment

Treatment of DeQuervain’s is more successful if started early. Initial treatment for a very acute or inflamed tendon might involve immobilization of the thumb and the wrist in a splint or brace. This allows for early healing and prevents aggravating the inflammation. In addition, the use of painkillers might be useful. However not everyone might need immobilization. Often physiotherapy treatment will settle the condition adequately. Physiotherapy treatment includes the use of Ultrasound in the initial phase to help settle the inflammation. This is progressed to graded stretching and strengthening to prevent irritation of the tendons. Patients’ habits and work styles are often observed by the therapist to suitably advice activity modification. Patients should avoid repetitive thumb and wrist movements that flares up the pain. Occasionally when the pain does not settle, a corticosteroid injection might be useful. For a few cases that are resistant to conservative management surgery might be an option.