De Quervain’s Tenosynovitis
What is de Quervain’s tenosynovitis?
De Quervain’s tenosynovitis or “mummy thumb” is a common hand condition that arises from overuse of the thumb and wrist. It is a painful condition that involves the inflammation of thumb muscle tendons located at the side of the wrist below the thumb. Over time, this can cause thickening of the tendon sheaths (soft tissue coverings encasing the tendons), making it difficult for the tendons to glide through the sheaths when moving and using the thumb in daily activities.
De Quervain’s tenosynovitis may occur after acute traumatic injuries (e.g. sustaining a blunt force impact over the wrist, forceful twisting of the thumb and wrist). Most cases, however, often occur from overuse of the wrist and thumb, leading to increased frictional forces or microtrauma to the affected tendons and their sheaths.
Some examples of activities which may lead to or aggravate de Quervain’s tenosynovitis symptoms include:
- Activities that require prolonged use and repeated movements of the wrist and thumb, such as mobile phone use, housework, sports activities, and office work.
- Mothers of newborns who are repeatedly lifting a baby or who are assuming breastfeeding postures that place the wrist and thumb in awkward positions.
How do I know if I have de Quervain’s tenosynovitis?
Signs and symptoms of de Quervain’s tenosynovitis may include:
- Pain and/or swelling over the wrist, below the base of the thumb.
- Catching or snapping sensation when moving the thumb.
- Feelings of stiffness and loss of mobility over the wrist and thumb (especially upon waking up in the mornings).
How is de Quervain’s tenosynovitis diagnosed?
Your specialist Doctor will obtain your health history and perform a physical examination. Radiological investigations (e.g. X-rays, CT scans) are usually not needed.
How is de Quervain’s tenosynovitis treated?
It is important to seek early treatment for de Quervain’s tenosynovitis as non-surgical treatment success rates may decrease as severity of de Quervain’s tenosynovitis may worsen with time. Treatment options for De Quervain’s tenosynovitis include both non-surgical and surgical interventions. For de Quervain’s tenosynovitis that is mild to moderate in severity, non-surgical treatment (such as Hand Therapy) tends to be effective, while severe cases may require surgical interventions.
De Quervain’s tenosynovitis cases that are mild to moderate in severity often respond well to non-surgical treatment, which largely involves resting of the affected thumb/wrist to allow inflammation to subside naturally, as well as specific exercises targeted at preventing thumb/wrist stiffness and improving strength. Your specialist Doctor may refer you to our Hand Therapist, who will be able to provide the following services:
- Advice and education pertaining to your condition
- Wax therapy
- Ultrasound therapy
- Advice on lifestyle and activity modifications so as to eliminate or minimise daily activities or thumb/wrist movements which may further aggravate the condition
- Provide a customised splint to be worn over the affected thumb/wrist when you are using your hands to perform daily activities so as to provide support and encourage further rest of the thumb/wrist
- Soft tissue mobilisation and release
- Appropriate exercises to improve thumb/wrist joint and muscle movements while avoiding aggravation of de Quervain’s tenosynovitis symptoms
- Progressive strengthening exercises of the thumb/wrist after the inflammation subsides so as to prevent future recurrence
- Pain relief/management
- Personalised home exercise program
Your Doctor may suggest other non-surgical interventions such as anti-inflammatory medications, or corticosteroid injections over the site of inflammation which can also help reduce inflammation and pain over the involved thumb/wrist.
If de Quervain’s tenosynovitis symptoms are severe or do not improve over time with non-surgical interventions, your Doctor may recommend a de Quervain’s release surgery. Hand therapy is often required after surgery to help regain the movement, strength and function of the affected thumb/wrist.