 |
 click to enlarge |
Named after the Swiss surgeon who described the disorder, deQuervain's tendinitis occurs when the tendons along the thumb side of the wrist become irritated and cause the tendon lining (the first dorsal compartment) to swell. The tendons then no longer glide easily through the lining, resulting in pain and tenderness along the thumb side of the wrist--especially when gripping objects or twisting the wrist.
Inflammation of the tendons along the thumb side of the wrist cause deQuervain's tendinitis. While deQuervain's tendinitis can occur for no clear reason, it often develops after unaccustomed and/or repetitive lifting or side-to-side motions of the wrists. For that reason, it is a common condition among performing artists such as pianists and bassists, but it can also be caused by something as simple as a new mother using awkward hand positions to care for her baby.
Many repetitive activities in the office setting can also contribute to deQuervain's. While typing, moving the wrist continually toward the small finger or always contracting the thumb muscles over the space bar are two examples. Also, forceful and continuous pinching while filing or writing are two other causes. The best way to avoid these overuse problems is to be well-conditioned for the activity and to avoid dramatic variation in the day-to-day amount of time spent on the particular tasks. People who spend eight hours a day/five days a week doing a particular task rarely develop these problems. Rather, it is the occasional typist who works on a project for three days straight who often experiences the onset of pain. Other ways to decrease the risk of developing deQuervain's include relaxing your thumbs while typing or alternating thumbs when typing the space bar. When typing, move your hand and wrist together as one and keep your wrist in a neutral position. Use rubber fingertips while filing and rubber grips on pens (either built-in or added on) while writing so you don't pinch as forcefully.
The main symptom of deQuervain's tendinitis is pain and tenderness along the thumb side of the wrist. This pain can travel up the forearm, and is usually at its worst when gripping objects or twisting the wrist. Other possible symptoms include swelling, difficulty in moving the thumb and wrist, numbness on the back of the thumb and index finger, or an occasional "catching" or "snapping" when moving the wrist.
To diagnose deQuervain's tendinitis, a physician will usually perform a Finkelstein test, in which the patient makes a fist with the fingers over the thumb and then bends the wrist in the opposite direction of the thumb. This test will cause pain directly over the first dorsal compartment at the base of the thumb. The physician will also rule out basal joint arthritis--which has some similar symptoms--by determining the point of maximum tenderness and performing the carpometacarpal compression test. During this test, the thumb is pressed firmly against the wrist bone while moving the basal joint to see if there is pain and/or a gritty feeling that usually signifies basal joint arthritis.
Sometimes simply avoiding the painful, exacerbating activities will relieve the symptoms of deQuervain's tendinitis. For mild cases, a splint and anti-inflammatory medicine for 2-3 weeks will generally relieve the pain. For more severe pain, oral or locally injected corticosteroids are more effective.
If the symptoms are severe and/or non-surgical methods fail to eliminate the pain, surgery may be recommended. This minor outpatient procedure, performed under local or regional anesthesia, involves opening up the first dorsal compartment to make more room for the inflamed tendons. After surgery, the wrist is covered for 10 to 14 days in a plaster shell with the wrist in slight extension.
