Have you ever sat down to write checks for all those bills you owe or, with one
eye open, grabbed your first-of-the-morning cup of coffee only to experience pain and burning in your wrist, right around your thumb? Sorry, it’s not writer’s cramp or an overweight coffee mug, but it could be De Quervains Tendonitis.
What’s that, you query? Glad you asked. De Quervains Tendonitis is a condition that manifests itself with pain, often times burning and swelling of the tendons around the base of the thumb as they cross the wrist.
This condition usually arises from a situation of overuse; keyboard activities, writing (remember all those bills?), repetitive overuse such as hammering and gripping. It can even be seen in pregnancy because of generalized tissue swelling. De Quervains tendonitis typically evolves slowly and isn’t really noticed until swelling and inflammation is moderate.
From an anatomical perspective, the area of your wrist and thumb in question is affectionately known as the “anatomic snuff box” (all you history buffs out there can look that up). It is located on the thumb-side of the wrist just below the thumb. It is here that the main tendons that activate various thumb motions; abduction (spreading of the thumb away from the hand) and extension, pass over the wrist and into the thumb. They are held in place by a thick band of tissue that creates a “tunnel” through which they pass.
So, what are the symptoms? The most common symptoms include pain, burning, and difficulty with performing various activities that involves the use of these tendons such as those described earlier, together with pain with various motions of the wrist.
How is it diagnosed? Typically by physical examination. One test used is called the Finklestein Test. It involves gripping the thumb in your hand and bending the wrist toward the little finger. Pain with this maneuver is a positive indicator.
OK, how is it treated? Treatment options typically begin with the most conservative methods and work their way up the aggressive ladder. In mild cases, non-steroidal anti-inflammatory drugs are a front line option, as is the use of oral analgesics (pain medications).
Activity modification is also quite helpful. Eliminating the activities or motions that cause the symptoms can go a long way in reducing pain and swelling. This can be accomplished by cessation of the activity itself or using various types of splints to restrict motion of the thumb and wrist.
If these options fail to solve the problem, we begin to move up the treatment ladder to more aggressive options. Here, treatments such as cortisone injections, physical therapy for ultrasound and iontophoresis – the administration of a steroid drug or local anesthetic topically through the use of electronic equipment are employed and can be successful in moderate-to-severe cases. Many times these are used in concert with activity restriction and immobilization of the thumb.
When all else fails and you just can’t get a “grip” on the symptoms, surgical release may be required. This is performed by making a small incision on the thumb side of the wrist exposing the underlying band of tissue (a.k.a. “pulley”) that covers the tendons. Next, the band is incised, effectively releasing pressure on the tendons.
It should be mentioned here that the source of the pressure is usually not the band of tissue, rather from swollen, inflamed tendons and their surrounding sheaths that have significantly reduced the space inside the tunnel for tendon mobility.
Once the band has been released it is left like that. Tendons are inspected for any damage caused by the friction from inflammation and edema (swelling). Occasionally, cortisone is introduced over the tendons and into the tunnel where it can bathe the structures. The wound is then closed and dressing applied, often incorporating the thumb for mobility restriction.
Healing time is typically 10-14 days for the wound, and activity restrictions can vary depending on variables such as job duties.
So, if check writing and coffee consumption is becoming increasingly painful, it may not be the checkbook or coffee mug…it could be De Quervains tendonitis. Get it checked out before it becomes too severe.
Don’t thumb your nose at this one.
Chisholm’s expertise in nursing, orthopedics and surgery spans more than 30 years. He holds multiple national certifications in these specialties. His goal is to empowering people through education and information to become more engaged, proactive and responsible in their orthopedic health, and health care. For additional information on orthopedic related topics, visit Ken’s Web site at www.bone-and-joint-pain.com.
One test for diagnosing De Quervains Tendonitis is the Finklestein Test, which involves gripping the thumb in your hand and bending the wrist toward the little finger. Pain with this maneuver is a positive indicator. (Photo courtesy of uoregon.edu)