De Quervain’s tenosynovitis… A common cause of wrist pain

A painful wrist is a very common symptom that affects many people. With the rise in the use of computers and mobile phones, this is becoming a bothersome issue for many. The Covid pandemic saw a resurgence of this problem due to online work in most workplaces.

One of the common causes of wrist pain is a condition called De Quervain’s tenosynovitis of the wrist. It was first described in 1895 by Fritz De Quervain.

It occurs when the two tendons around the base of your thumb become swollen. The swelling causes the sheaths (casings) covering the tendons to become inflamed. The cause is usually repetitive use of the wrist and thumb.

Symptoms

Pain at the base of the thumb and wrist are the usual symptoms. It is worse on movements or repetitive use.Sometimes the pain may radiate up to the forearm and may cause some numbness in the hand and thumb.De Quervains tenosynovitis is common in women, after pregnancy, or after injuries to the wrist and also ina rthritis. It is common in professions involving the repetitive thumb and wrist movements.

Investigations

The diagnosis is done by a thorough history and clinical examination. Finkelstein’s test is done by the physician to diagnose this condition. Investigations like x-rays are usually not needed.

Management

The first line of treatment is usually conservative or non-interventional. This includes medications like non-steroidal anti-inflammatory medication, topical gels and wrist/thumb splints to alleviate the pain. Physiotherapy for the affected part can help.

If this treatment fails, one of the first interventions is a local steroid injection at the affected site. This can help to reduce the pain and improve movements.

If injections fail, a small surgical release of the tendons can be done under appropriate anesthesia. The surgeon will release the tendon sheath around the constricted tendons and this usually works as a permanent treatment.