This article is about De Quervain's Tenosynovitis and also its sister condition, Intersection Syndrome. Its main aim to is to provide information and advice about the condition with an emphasis on self-help. The information is also provided in video format below.
The article is written on the assumption that the reader has been diagnosed with De Quervain's or Intersection Syndrome by a healthcare professional. If you haven't been diagnosed but think you might have the condition then it's best to get checked out first as there are some other conditions that can cause similar symptoms.
The article addresses the condition by answering the 3 most common questions that people ask after they have been diagnosed.
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| Dr Fritz de Quervain |
The main area of tenderness is usually around a bony area on the thumb side of the wrist called the radial styloid. If you slide your finger off this bone towards your thumb and then lift your thumb upwards as if hitching a lift, you should be able to feel the tendons tighten up, and this is usually the area of maximum tenderness (see above right).
Another test you can do for De Quervain's is called the Eichhoff's test, which is similar to the Finkelsteins Test that a clinician may do when examining you, but you can do the Eichhoff's test yourself.
The test is done by bringing your thumb across your palm and then very slowly angling your wrist downwards in the direction of your little finger. It can be very painful if you have an acutely irritable case of De Quervain's so go easy! The test is positive if it reproduces familiar pain over the typical region. See the video below for a demonstration of the Eichhoff's test.
Sometimes the pain may be a little further into the forearm at another area of potential friction, this time where our 2 tendons are crossing over a neighbouring set of tendons lying underneath. This is actually a slightly different condition called Intersection Syndrome but we treat it the same way as De Quervains Tenosynovitis and so for the purpose of this article we can bundle the 2 conditions together.
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2) Why have I got it ?
The condition is essentially an overuse injury of the wrist which aggravates the APL and EPB tendons. The type of activities that typically cause the condition can be heavy lifting or strenuous activity eg. Gardening or heavy manual work, or perhaps a sudden wrist sprain due to an injury.
More typically though, it is caused by low level repetitive activities over many weeks or months. Things like general housework, crafting, golf or racket sports. Phone texting and playing computer games have also been found to be increasingly common causes of the condition, earning it the alternative name of 'Gamers Thumb'.
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| De Quervain's is also known as 'Gamers Thumb' |
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| Radial and Ulnar Deviation |
3) What can I do about it ?
Reducing / Modifying Wrist Activity
De Quervain's will usually settle down slowly over a few weeks by following the self-help advice and treatments below. If it isn't well on the way to improving after 6 weeks then you should see your clinician again as you may require one of the other treatments mentioned later in the article.
a) Reduce the Load
Because this is an overuse condition, the first and most important thing you must do is reduce the activity that is causing the problem. Otherwise you will be fighting a losing battle. If you can't stop the activity completely, which may well be the case if your job is the cause (or indeed picking up your children) then at least try to limit the activity much as possible.
If its an occupational overuse problem then talk to your employer about the option of lighter duties for a while or making some workplace adjustments to reduce your wrist strain. In an office, using an ergonomic keyboard and mouse can be helpful in reducing occupational wrist strain.
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| Ergonomic Mouse eg. Penguin Mouse |
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| Ergonomic Keyboard |
b) Splints
Wearing a wrist splint can also be really helpful in reducing the stress through the tendons and is the main self-help treatment that you can try. I often see people using thumb splints for De Quervain's but they don't tend to work so well because this is a wrist condition, as the overuse movement that causes it is that up and down karate chop movement of the wrist. So the right type of splint should be one that supports the wrist and limits wrist movement.
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| Standard Wrist Splint |
A wrist splint which has a metal support bar sewn in should be effective. You can also get splints which support both the wrist and thumb which will be really effective but you might struggle to do much with your hand while wearing it as it works a bit like a plaster cast.
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| Wrist & Thumb Splint |
The best splint for you will depend on what you still need to do with your hand whilst wearing it. Try to use the splint as much as possible when active during the day. Unless it's very painful at night, then you don't usually need to use it in bed.
c) Medication
Another good self help treatment is the use of anti-inflammatories. Because this is a condition of tendon sheath inflammation, an anti-inflammatory drug can often be very helpful. Please talk to a prescriber or a pharmacist first though as not everyone can take anti-inflammatories.
You can take a course of tablets such as ibuprofen over a few weeks but using the gel is often just as effective and has less side effects. Because these tendons are so close to the skin surface, an anti-inflammatory gel can penetrate to the right depth and effectively treat the tendon sheath inflammation. It's usually best applied around 4 times daily but read the packet to see what the optimal dose is for the type of gel that you have.
SUMMARY
So to summarise, stopping or reducing the aggravating activity and then using a wrist splint alongside anti-inflammatory gel over a 6 week period can often settle down the majority of cases of De Quervain's Tenosynovitis.
Additional Treatment Options
For the stubborn cases that don't improve then the usual next step in treatment is a cortisone injection. A small dose of cortisone injected into the tendon sheath has a 70-80% success rate in curing the problem and can often start working within a few days. The injection can be repeated if it doesn't the get the problem fully better first time round.
And finally if the problem persists despite trying all the things we have discussed so far then you may need to talk to a hand surgeon about the option of surgery.
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| Surgeons View of the APL and EPB tendons |
Surgery is usually considered a last resort option as with all surgery there are potential risks, and with this particular operation, there is a risk of irritating a nearby nerve which can cause prolonged pain and discomfort in some patients.
The tunnel will heal over again within a few weeks but it generally heals in a wider position with less tension on the tendons and so hopefully the condition doesn't come back again.
The surgery for Intersection Syndrome is also considered a last resort option and involves trying to remove the swollen and inflamed tendon sheaths at the point where they rub against each other.
Both procedures are often done under local anaesthetic and involve a large bandage for about 10 days until the stitches come out and then a splint for a few more weeks. It can take up to 3 months before everything has settled down fully.
And thats it! I do hope that you found the article helpful, particularly in showing you how to settle the condition down yourself, and we've discussed some of the other treatment options available if the problem persists despite your best efforts. Many thanks for reading.
Stephen Bunting 2022
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