De Quervain's Tenosynovitis

A tendon is a group of cord-like fibers that attach a muscle to a bone. The tendons of the wrist and thumb are encased in a sheath. Tendons and the sheaths can become irritated either through overuse or trauma. De Quervain's is an irritation in the tendon sheaths in one or both of two muscles of the thumb. Often a small nodule can be felt on the tendon. This condition is thought to be from overuse, frequently from excessive writing. It is basically a form of tendonitis that also affects the sheath of the tendon.

Symptoms

Pain is a primary symptom. It will be located in the area of the "snuffbox" of the wrist. This is the area of the wrist at the base of the thumb that forms an indentation when you extend the thumb. The tendons that form this "snuffbox" are the ones that are involved. As mentioned before there may also be one or more nodules on the tendons that make the "snuffbox."  Pain usually begins slowly and increases over several weeks. The discomfort is commonly described as hot or burning and the areas may actually feel warm or be red.

Activities that are problematic include bending and straightening the thumb or bending the wrist in the direction of the little finger. In severe cases, any movement of the thumb may be difficult.

Treatment

Treatment depends on the severity of the inflammation. Your physician may prescribe anti-inflammatory medications, and rest is a primary consideration. Since the tendon attaches directly to the muscle, use of the thumb places stress on the tendon, which will continue to irritate the tendon. A splint may be issued to temporarily immobilize the affected area and prevent use of the muscle.

Therapeutic modalities such as ultrasound, electrical stimulation, heat or ice may decrease pain and inflammation. A modality known as iontophoresis may also be used. Iontophoresis is another way to introduce anti-inflammatory medicine to areas that are bony.

There are therapeutic exercises and stretches that can speed  recovery and return you to pain-free function. It is important to follow the guidelines for rest and exercise, because tendonitis can become reinflamed very easily. If you have had multiple episodes of tendonitis in the same area over several years, you may find it takes longer to heal.

Sometimes your health professional may do a procedure known as friction massage. This manual therapy procedure is sometimes helpful, although not very comfortable.

If symptoms persist for a long time, anti-inflammatory injections may be used. Surgery may be advised in some cases. Consult your doctor or health professional for further information.