De Quervain’s Tenosynovitis

What is De Quervain’s Tenosynovitis?

A painful condition affecting the tendons of the thumb is known as De Quervain’s Tenosynovitis.


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Its Anatomy & Causes

Tendons, long cord-like structures attach between the muscle to bone. There are two sets of tendons connecting the wrist to the thumb. The tendons pass through a tunnel known as tendon sheath, which helps to glide smoothly when the thumb straightens and bends.

Prolonged overuse of the wrist and thumb due to repetitive movements can lead to thickening, swelling and inflammation of the tendon and its sheath, resulting in increased friction between the structures. This can give rise to intense pain when moving the wrist, or when using the thumb to grasp or pinch.


Symptoms

  • The main symptom is pain felt over the thumb side of the wrist, and can spread upwards to the forearm. The pain tends may develop slowly over time and with increased thumb movements involving grasping or pinching, or on wrist rotation.
  • Swelling can be seen over the thumb side of the wrist. At times a fluid-filled cyst can also be seen
  • Difficulty in moving the thumb and wrist
  • A catching or snapping sensation in the thumb when one moves it

Risk Factors

Some of the risk factors for De Quervain’s Tenosynovitis include:

  • People whose occupations or hobbies involving long and continuous overuse of the wrist and having to repeatedly grasp or pinch with the thumb
  • Common occurring between the ages of 30 to 50 typically
  • Past injury to the wrist or base of the thumb resulting in a buildup of scar tissue
  • It is found more common in women than in men
  • Certain medical pre-conditions such as pregnancy and rheumatoid arthritis

Diagnosis

Doctor could diagnose De Quervain’s Tenosynovitis, after a detailed history and physical examination of the wrist and affected thumb. Typically, no investigations or X-rays are required.


Treatment

The type of treatment for De Quervain’s Tenosynovitis varies with the severity:

  • Avoidance of the causative activity
  • Painkillers such as paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Gentle exercises to strengthen the muscles and reduce irritation to the tendon, relieving the pain
  • Wearing a splint to immobilize the wrist and thumb
  • Extracorporeal Shockwave Therapy (ESWT). This is a painless and non-invasive procedure which causes improvement in blood circulation and a tissue-repairing effect on the inflamed tendons
  • Corticosteroid (H&L) injection. This is the injection into and around the tendon sheath, to reduce the inflammation. The effect may be temporary, usually last around 3 months, and sometimes may last a year or longer. More than one injection may be necessary.
  • If all else fails, surgery should be considered. The process involves releasing the tendon to allow it to glide freely, and is usually performed under local anaesthesia.

Dr. Tan & Partners @Siglap

Joint Pain, Men’s Health & Sexual Health Clinic

Dr. Edwin Ong is currently practising in Men’s Health & Sexual Clinic @Siglap 


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914 East Coast Road
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Telephone:
+65 6962 2144

Email: hello@dtapclinic.com

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