What is Tenosynovitis?
DeQuervain’s Tenosynovitis is a cause of wrist pain. It is common after repetitive motion. But I have seen it develop after a minor trauma such as fall.
DeQuervain’s is a type of tendonitis which involves an inflammation of a covering (sheath) around a tendon.
Remember, a tendon connects a muscle-to-bone. The wrist has multiple tendons crossing over it to bring its uniques qualities of both strength and a dexterity. As seen in the photo, the tendons originate in the forearm and travel to the thumb.
Photo Credit: M0rphzone via Wikipedia
Quickcare or ER?
Since so many persons with DeQuervain’s will have it for weeks or months before seeking medical care, a scheduled appointment at an urgent care is adequate.
Red Flags that could send you to the ER include
- severe pain
- severe swelling
- Numbness or discoloration
The vast vast majority can easily be seen at an Urgent Care facility.
What will your doctor ask?
Your doctor will want to know your symptoms.
Remember, a symptom is your description of your condition to your doctor. It is your story. Most patients will present complaining of hand and wrist pain.
Some basic questions include:
How long have you had the pain?
Where does it hurt?
What makes it better?
What makes it worse?
Did you fall or have some form of trauma?
What will the doctor look for?
Your doctor will look for signs.
Remember, a sign is an objective finding that a doctor sees during the exam
The wrist exam is very important.
Swelling in the joint is a clue that something is wrong. Skin discoloration is another clue.
One thing that needs checking is the point over the snuff box. A sharp pain there could be a broken bone (Scaphoid) which is not to be missed.
The specific exam for DeQuervain’s Tenosynovitis is called a Finkelstein test. This is key!!
Put your hand out. Open up the palm. Bend the thumb into the palm. Close the other fingers over the thumb. Now bend the wrist. The stretching of tendon will cause pain. Voila! It must be it. Get it?
What is the doctor thinking?
Your doctor will want to think of the many possibilities for your pain. The list that is created is called a differential diagnosis.
Your doctor will come up with a differential diagnosis.
Some possible causes of this pain include:
Sprain This is an inflammation of the tendons or ligaments in the wrist joint
Strain This is a pulled muscle
What are the treatment options for De Quervain’s Tenosynovitis?
Like any inflammation in an extremity, it needs to be immobilized. That is, it needs a splint or brace.
I treat my patients with an anti-inflammatory drugs such as Motrin, Advil or Naproxen. Either are helpful. They decrease both pain and swelling.
If medications and splints do not help after a week, then I send patients to a physical therapist. The therapists have their own set of massages, stretches and exercises that are very useful.
If my patients are still not better….
then I send them to a bone specialist (Orthopaedic doctor) who may inject a steroid into the tendon. This will decrease the inflammation.
How long will you be sick with De Quevain’s Tenosynovitis?
Generally, the inflammation will last 2-3 weeks with anti-inflammatories, a brace/splint and physical therapy.
Once the pain gets beyond this time frame and the orthopaedic doctor is involved, about two more weeks are needed for resolution
Let me tell you a story
Buddy never had dreams. He sort of took things as they came along. His lack of planning got him stuck in a monotonous factory job. Little did he know he would be there for most of his adult life.
The bottles that he sorted were endless. Day-after-day. The only thing that changed was the time. It was ok as a young man. “At least I got a job,” he said to himself.
Now things are starting to creep up on him. First it was his back. Now it is his wrist.
Buddy did not fall or have trauma….So how bad could his wrist pain be? He told me, “Hmm, I doubt if anything is broken……Could it be just a simple sprain?”
In Buddy’s case, the pain was local, sharp and constant. It got worse with movement. There was no associated numbness or paralysis.
I splinted him with a Velcro thumb spica brace and kept him on light duties which included not using his effected wrist. The Naproxen prescribed calmed down the inflammation.
While on light duties, he had an opportunity to work in the office. Typing at a keyboard was so foreign to him. He gave up. Went back to his comfort zone-sorting bottles.
Hope this helps.