Ask a Doctor: de Quervain’s Tenosynovitis

Dr. Carl B. Weiss, an orthopaedic surgeon, answers your questions about de Quervain’s Tenosynovitis.

Q: What is de Quervain’s Tenosynovitis?

A: De Quervain’s Tenosynovitis is a condition caused by entrapment of some of the tendons going to your thumb.  These tendons, called the abductor pollicis longus and the extensor pollicis brevis, go through a snug tunnel at the wrist, called the first dorsal extensor compartment.  You can see the tendons on the back of your hand when you straighten your fingers. When, for whatever reason, the tunnel becomes too tight, it sets up a vicious cycle; whenever you move your thumb in certain ways, it pulls the tendons through the tight tunnel, causing pain and further aggravating the condition.

Q: How is the diagnosis made?

A: A hand surgeon can help determine if you have de Quervain’s.  If you have tenderness over the tendons and pain when you make a fist with your thumb tucked inside and bend the wrist with the pinkie facing down (see image), then you have what is known as a positive Finkelstein’s sign, which would indicate that you likely have de Quervain’s.  However, there are other causes of pain in this area, such as arthritis in the joint at the base of your thumb, which can feel similar to de Quervain’s.  Therefore, x-rays may be used to help make the diagnosis.  A hand surgeon can distinguish between these conditions, though it is quite possible that a patient has both.

Q: What causes de Quervain’s Tenosynovitis?

A: The cause of this condition is uncertain.  There seems to be some genetic component, as certain people have many related problems such as trigger fingers or carpal tunnel syndrome.  Some think that overuse may contribute, along with generalized swelling or conditions such as diabetes and thyroid disease.

Q: Who gets de Quervain’s Tenosynovitis?

A: Anyone can get de Quervain’s, but it is most common in women.  Younger women with the condition have often recently given birth or are breastfeeding.  If you are a new mother and you have recently developed a searing pain in your wrist near the base of your thumb, chances are you have developed this disease. It is also common in women in their fifties and sixties.

Q: How do you treat de Quervain’s Tenosynovitis?

A: Treatment can involve rest and splinting, cortisone injection, or, if all else fails, surgery to release the tight compartment.  Usually, by the time someone visits a hand surgeon with de Quervain’s, they are looking for relief from the sharp pain.  A cortisone injection often gives excellent relief in a short period of time.  If two to three injections are unsuccessful in resolving the condition, surgery is often considered.  There are risks to all forms of treatment, so treatment options should be discussed with your doctor.

Learn more about de Quervain’s Tenosynovitis at www.handcare.org.

Dr. Carl B. Weiss received his orthopedic surgery training at the State University of New York at Stony Brook. He then completed the Joseph Boyes Hand Surgery Fellowship in Los Angeles, California. Dr. Weiss is certified by the American Board of orthopedic surgery in both orthopedics and hand surgery. He is a member of the American Academy of Orthopedic Surgeons, the American Society for Surgery of the Hand, and the Southern Orthopedic Association. Dr. Weiss currently practices at James River Orthopedics, located on the campus of Memorial Regional Medical Center in Mechanicsville, Virginia.