What is de Quervain's tendonitis?
First dorsal compartment tendonitis, more commonly known as de Quervain’s tendonitis or tenosynovitis after the
Swiss surgeon Fritz de Quervain, is a condition brought on by irritation or inflammation of the wrist tendons at the base
of the thumb (see Figure 1, 1A). The inflammation causes the compartment (a tunnel or a sheath) around the tendon to swell and enlarge, making thumb and
wrist movement painful. Making a fist, grasping or holding objects—often infants—are common painful movements
with deQuervain’s tendonitis.
What causes de Quervain's
The cause of de Quervain’s tendonitis is an irritation of the tendons at the
base of the thumb, usually caused by taking up a new, repetitive activity. New mothers are especially prone to this type
of tendonitis: caring for an infant often creates awkward hand positioning, and hormonal fluctuations associated with pregnancy
and nursing further contribute to its occurrence. A wrist fracture can also predispose a patient to deQuervain’s tendonitis,
because of increased stresses across the tendons.
and symptoms of de Quervain's tendonitis
Pain over the thumb-side of the wrist is the main symptom.
The pain may appear either gradually or suddenly, and pain is located at the first dorsal compartment (see Figure 1, 1A) at the wrist. Pain may radiate down the thumb or up the forearm. Hand and thumb motion increases pain, especially with
forceful grasping or twisting. Swelling over the base of the thumb may include a fluid-filled cyst in this region. There
may be an occasional “catching” or “snapping” when moving the thumb. Because of the pain and swelling,
motion such as pinching may be difficult. Irritation of the nerve lying on top of the tendon sheath may cause numbness on
the back of the thumb and index finger.
de Quervain's tendonitis
Tenderness directly over the tendons on the thumb-side of the wrist is
the most common finding. A test is generally performed in which the patient makes a fist with the fingers clasped over the
thumb. The wrist is then bent in the direction of the little finger (see Figure 2 and 3). This maneuver can be quite painful for the person with de Quervain’s tendonitis.
Treatment of de Quervain's tendonitis
The goal is to relieve the pain caused by
the irritation and swelling. Your doctor may recommend:
- Rest the thumb and
wrist by wearing a splint
- Oral anti-inflammatory medication may be recommended.
- A cortisone-type of steroid may be injected into the tendon compartment as
another treatment option.
Each of these non-operative treatments help
reduce the swelling, which typically relieves pain over time. In some cases, simply stopping the aggravating activities
may allow the symptoms to go away on their own.
When symptoms are severe or
do not improve, surgery may be recommended. The surgery opens the compartment to make more room for the inflamed tendons,
which breaks the vicious cycle where the tight space causes more inflammation. Normal use of the hand can usually be resumed
once comfort and strength have returned. Your hand surgeon will advise the best treatment for your situation.
Figure 1: The first dorsal compartment. There are six
compartments on the dorsal, or back, side of the wrist. The first and third compartments house tendons which control the
de Quervain’s Tendonitis
Figure 2 and 3: Finkelstein maneuver, a helpful
test to diagnose de Quervain’s Tendonitis. Figure 2 shows the first dorsal compartment relaxed; Figure 3 shows the
compartment stretched when the fist is bent toward the little finger.
© 2009 American Society for Surgery of the Hand. Developed by the ASSH Public Education Committee