De Quervain’s Syndrome
What is De Quervain’s Syndrome?
De Quervain’s syndrome, medically known as de Quervain tenosynovitis, is a condition in which the sheath of tendons of the thumb on the wrist area becomes inflamed and thus painful. Pain occurs when patients extend their thumbs, move their wrists, reach or grab objects. Exact cause of this disease is not known, but repetitive movements of the thumbs or wrists are thought to be the possible cause.
What are the signs and symptoms?
Symptoms may include pain and swelling at the base of the thumb near the wrist, followed by difficulty to move the thumbs or wrists, usually with gripping and snapping. These symptoms occur due to the tendon sheath, which appears like a tunnel, becomes inflamed, causing it to thicken and narrow the surrounding space. Tendon will move through the narrowed tunnel and eventually cause pain.
What are the triggers?
Daily activities involve a lot of repetitive movements on the thumbs and wrists, such as pressing a stapler, washing clothes, mopping, and putting up screws. Movement while pressing a stapler will put on a pressure on the thumb, while twisting movements during washing clothes, mopping, and installing screws with screwdriver will put on pressures on the wrists.
Most of our activities involve the thumbs and wrists, which are unavoidable as they are a part of our daily routines. To prevent worsening, we may want to consider a change or modification in routines that will relieve the pressures on our thumbs and wrists. Why do we need adjustments? Because the pain that occurs is actually a reminder for us to let that injured part rest.
How do I know for sure?
One of the tests to diagnose de Quervain’s is to place your thumb over the palm, followed by bending your four fingers over the thumb, so now the thumb is grabbed by the fingers. Then, move your wrist to the side of your pinky finger. When a pain occurs then it is most likely that you have de Quervain’s syndrome.
What to do?
The main treatment for this condition is to rest the painful thumbs and wrists. Application of warm compresses in combination with nonsteroidal anti-inflammatory drugs (NSAIDs), prescribed by your doctors, can be used. You are also suggested to use a splint so that the movements of your thumbs and wrists become limited and minimized. When symptoms do not seem to improve, then you may seek further medical attention. Treatments by doctors may include corticosteroid injections or even surgical procedures, only if the symptoms interfere with patients’ daily activities. Minor surgery in fully awake condition can be done by using a local anesthetic and small incision by a hand surgeon (plastic surgery or orthopedic based). That incision will give access to “cut” the thickened and stiff sheath. By cutting the tendon sheath, it is expected that the narrowing becomes improved so that pain will be relieved when the thumb or wrist is moved.
Written by Dr. Teddy Prasetyono and dr. Amila Tikyayala
Division of Plastic Surgery, Department of Surgery
Dr. Cipto Mangunkusumo Hospital / Faculty of Medicine, Universitas Indonesia
Translated by Illona Andromeda, M.D.