De Quervain’s Tenosynovitis aka “Mummy Thumb” (Part 2)

How will the doctor diagnose de Quervain’s tenosynovitis?

Individuals afflicted by de Quervain’s tenosynovitis often present with pain and swelling over the side of the wrist at the base of the thumb. Applying pressure over this area often elicits pain or tenderness, as does performing activities that include repetitive and/or forceful pinching of the thumb (e.g. pulling up pants, prolonged use of tongs or scissors).

The doctor may also conduct a Finkelstein’s test, which involves bending the thumb across the palm and holding it in place with a loose fist, followed by bending the wrist in the direction of the little finger. A positive test would elicit pain over the side of the wrist at the base of the thumb.

How can de Quervain’s tenosynovitis be treated?

Treatment options for De Quervain’s tenosynovitis include non-surgical and surgical interventions. For de Quervain’s tenosynovitis that is mild to moderate in severity, non-surgical treatment tends to be effective, while severe cases may require surgical interventions. 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.

Non-surgical Treatment Options

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 to prevent or alleviate thumb/wrist stiffness. Your doctor may refer you to an occupational therapist, who will be able to provide the following services:

  • Advice on lifestyle and activity modifications so as to eliminate or minimize daily activities or thumb/wrist movements which may further aggravate the condition (e.g. heavy housework, lifting of heavy loads, active/repetitive/forceful pinching activities).
  • 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. Resting will help reduce inflammation and its associated symptoms (i.e. pain over the side of the wrist at the base of the thumb).
  • Teach appropriate range of motion and stretching exercises that can help reduce thumb and wrist stiffness while avoiding aggravation of de Quervain’s tenosynovitis symptoms.
  • Use of therapeutic modalities such as heat treatment and ultrasound therapy, which may provide temporary relief of de Quervain’s tenosynovitis symptoms.

Other non-surgical interventions your doctor may prescribe include: 

  • Short-term oral medications (e.g. non-steroidal anti-inflammatory drugs) to help reduce inflammation and pain.
  • Corticosteroid injections over the site of inflammation which can also help reduce inflammation, pain and triggering over the involved thumb/wrist. These injections are usually done a maximum of two times over the same area. If de Quervain’s tenosynovitis symptoms still persist after two injections, surgery may be considered.

Surgical Treatment Options

Surgical interventions to help relieve de Quervain’s tenosynovitis symptoms may be recommended in the following situations:

  • The symptoms of de Quervain’s tenosynovitis do not improve over time with non-surgical interventions.
  • De Quervain’s tenosynovitis symptoms have been present for prolonged periods of time (i.e. more than six months) and has been diagnosed to be severe in nature.

The surgical procedure for de Quervain’s tenosynovitis is commonly called a “de Quervain’s tendon release”. The goal of this procedure is to reduce pressure over the affected tendons by opening the covering (sheath) over the tendons, thereby making more room for the tendons to move freely without pain. This is done by making a small incision over the side of the wrist at the base of the thumb and cutting a small slit in the sheath surrounding the tendon. 

Recovery from de Quervain’s release surgery can take anywhere from several weeks to several months. Occupational therapy is often required after surgery to help regain the movement, strength and function of the affected thumb/wrist.

Precautions

Even after your symptoms have subsided after non-surgical interventions (i.e. therapy and/or steroid injections), there is still a risk of it recurring if you continue using your hands to perform strenuous activities frequently. As such, precautionary measures should be considered when performing daily activities (e.g. household chores, cooking/baking activities, work tasks) to avoid a recurrence of the condition. These measures include:

  • Lifestyle modifications to avoid or minimize activities that require repetitive and/or forceful pinching (e.g. using your thumb to operate your mobile phone for prolonged periods of time, cutting objects with a pair of scissors, serving food with tongs, frequent use of clothes pegs when hanging laundry, inappropriate methods of lifting or carrying babies/young children).
  • Use larger upper limb joints to carry loads instead of using your thumb and fingers to grasp objects (e.g. carrying your laptop/tablet by supporting it with your palm and forearm, instead of carrying/lifting it with your thumb and fingers).
  • Take frequent short rest breaks (every 20 to 30 minutes) when performing strenuous activities, household chores or work tasks to allow adequate rest of your hands.
  • Practice activity pacing to prevent overstrain of your hands and wrists (e.g. plan to perform strenuous activities, such as household chores and grocery shopping trips, over a few days instead of completing everything on a single day).
  • Once you start feeling any pain or strain over your thumb or wrist, rest them well over the next few days. 

Sources:

Allbrook, V. (November 2019). ‘The side of my wrist hurts’: De Quervain’s tenosynovitis. Australian Journal of General Practice, 48(11). Retrieved August 27, 2021, from https://www1.racgp.org.au/ajgp/2019/november/side-of-my-wrist-hurts

American Academy of Orthopaedic Surgeons. (2013). De Quervain’s Tendinosis. Retrieved August 27, 2021, from https://orthoinfo.aaos.org/en/diseases–conditions/de-quervains-tendinosis/

Physiopedia. (2021). De Quervain’s tenosynovitis. Retrieved August 27, 2021, from https://www.physio-pedia.com/De_Quervain%27s_Tenosynovitis

Wolf, J.M., Sturdivant, R.X., & Owens, B.D. (January, 2009). Incidence of de Quervain’s tenosynovitis in a young, active population. The Journal of Hand Surgery, 34(1), 112-115. Retrieved August 27, 2021, from https://sci-hub.do/https://doi.org/10.1016/j.jhsa.2008.08.020

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