It is a painful swelling (inflammation) of specific tendons of the thumb causing severe thumb pain. Its proper name is De Quervian’s Tenosynovitis and is commonly called as Dequervain’s disease or de Quervian’s syndrome.
How such condition develops?
Tendons are fibrous bands of tissues that connect muscle to bone. Normally tendons slide easily through a tunnel of tissue called sheath. The sheath surrounds a tendon and keeps it in place next to the bones, here, to the bones of the wrist /thumb.
This type of wrist pain occurs when two tendons around the base of the thumb swell. When the swollen tendons rub against the narrow tunnel – the sheath they pass through, it causes pain due to the pressure on the nearby nerves at the base of the thumb and also into the lower arm. Women are more vulnerable to this disease especially the pregnant women and those between the age group of 30 to 50 years.
Conditions that cause / amplify Dequervain’s disease
Although in many cases the exact cause of Dequervain’s Tenosynovitis remains unknown, however, mostly it occurs due to following reasons –
- A direct blow to the thumb, certain occupations and hobbies in which there is continuous random movement like gaming, gardening, knitting, playing musical instruments or racket sports. Overuse, repetitive work tasks are generally the main cause.
- Patients with inflammatory conditions like rheumatoid arthritis are more susceptible.
- Hormonal changes during the pregnancy increases the chances of Dequervain’s disease. It typically appears 4 to 6 weeks after delivery. Parenthood, while lifting the child again and again with a pressure on the thumb and wrist may be another
- Wrist injury must be avoided; the scarred tissue can restrict the movement of the tendons.
- Pain along the back of the thumb will be noticed, directly over two tendons.
- A swelling too could be seen on the side of the wrist near the base of thumb, this swelling may accompany a fluid filled cyst in the region.
- The symptoms can be observed to be appearing gradually or in some cases even suddenly. In both the cases the thumb pain persists & may travel in opposite direction that is towards the
forearm. It may be hard or painful to move the thumb particularly while trying to grasp things or pinching.
- Tenderness near the base of the thumb or numbness along the back of the thumb and index finger, a catching or snapping feeling when the thumb is moved can also be felt.
- A squeaking sound, as the tendons move within the swollen sheaths, may be observed.
The doctor first checks the hand to see if it hurts when he puts pressure on the thumb side of the wrist. Finkelstein test is the next step. In this the doctor asks to bend the thumb across the palm. Then bend down the fingers over the thumb to make a fist and lastly bend the wrist towards the little finger. Other tests such as X-ray are usually not required to diagnose it.
What all can be done to relieve the thumb and wrist pain?
If the treatment begins at an early stage the conditions will improve within 4 to 6 weeks. Initially the treatment is aimed at reducing inflammation, preserving the movement in the thumb and finally preventing the recurrence.
- The non surgical treatments can include application of ice to the thumb and wrist area. This will reduce swelling.
- Avoiding activities through the affected thumb like pinching with it while moving the wrist in sideways. Using splints. Splints may be worn to give rest to the wrist and thumb and stop its movement. Usually it has to be worn whole day long for 4 to 6 weeks.
- Medications too can be used in treating Dequervain, if symptoms still persist the doctor may give pain relievers and anti inflammatory medicines.
- The surgical treatment is recommended if the symptoms are severe or don’t improve after non surgical methods. The aim of surgery is to open the thumb covering to give more space to the irritated tendons ultimately decreasing the pain and inflammation in the affected area. Surgery is typically done under the local anaesthesia or with mild sedation
After the recovery the physician will recommend an exercise program to strengthen the thumb and wrist. The time of recovery varies depending on the age, general health and for how long the symptoms have been present. In cases that have developed gradually, it is usually difficult to manage. It may take longer for symptoms of thumb pain or wrist pain to disappear and for the thumb and wrist to regain their normal range of motion.
So to avoid Dequervain’s disease, take frequent breaks while working with the wrist, avoid repetitive thumb movements and follow some basic exercises related to thumb and wrist.