De Quervain's Tenosynovitis: Test, Splint & Treatment

Instructor: Kirstyn Wade

Kirstyn is a registered nurse and has a master's degree in Nursing Education. She has taught college Nursing courses.

De Quervain's tenosynovitis is a condition that affects the tendons in the thumb and wrist. While not life-threatening, it can be debilitating and interfere with daily life. In this lesson, you'll learn more about the condition and how it's treated.

Wrist Pain

Megan, a 33-year-old mother, and avid gardener spends most of her free time outside in her vegetable and flower gardens. She loves the hands-on work that goes into planting and cultivating. However, she has been having trouble this year keeping up with her gardens. Megan has been having increasing pain in her left wrist, particularly along the thumb side of her wrist.

She finds the movements of grasping at weeds, holding garden tools, and digging in the soil to be very uncomfortable. Furthermore, she's having an even harder time lifting her two young children without causing additional pain in her wrist. She decides to make a doctor's appointment, and her physician diagnoses her with de Quervain's tenosynovitis.

Pain in the wrist and thumb.
Wrist Discomfort

De Quervain's Tenosynovitis

De Quervain's Tenosynovitis is an inflammation of the two tendons at the base of the thumb. These tendons extend the length of the thumb and are surrounded by a sheath, or a lubricating membrane layer allowing the tendon to stretch and not adhere to surrounding tissues. The tendons themselves or the tendon sheath can become swollen and irritated causing increased friction and pain in the thumb and wrist, and sometimes extending up the forearm.

The exact cause of de Quervain's tenosynovitis is unknown, but overuse of the tendons and a history of chronic, repetitive movements seem to be associated with the condition.

Symptoms of de Quervain's tenosynovitis can include the following:

  • Pain and swelling in the lower portion of the thumb.
  • Pain with grasping, making a fist or turning the wrist.
  • A feeling of 'catching' when trying to move the thumb.
  • Increased pain when doing certain repetitive movements, such as lifting a baby, gardening, racket sports, or even typing on the computer.

The Finkelstein Test

De Quervain's tenosynovitis is diagnosed after a simple examination by a doctor. A doctor will examine the thumb and wrist for swelling, and apply gentle pressure to the base of the thumb to determine if this causes additional pain. The doctor will also perform the Finkelstein test, which involves placing the thumb across the palm, folding the other fingers over the thumb forming a fist, and then bending the wrist downward, toward the floor. This movement causes intense pain if a person has de Quervain's tenosynovitis.


Depiction of the Finkelstein Test.
Finkelstein Test


Treatment

The main goal of treatment of de Quervain's tenosynovitis is reducing inflammation in the affected tendons and pain management. Anti-inflammatory medications, such as ibuprofen or Aleve, are often prescribed to help alleviate pain and reduce inflammation, along with ice and rest.

A doctor may also recommend corticosteroid injections to reduce inflammation. Corticosteroids are a class of hormone steroid medications that are used for a variety of health problems, such as skin conditions, pain and inflammation of joints, and asthma. For de Quervain's tenosynovitis, corticosteroids are often used in an injectable form directly into the tendon area.

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