De Quervain Tendonitis: A Thumb’s Silent Cry for Help

The late afternoon sunlight streamed through the window as I walked into a local art exhibition. My friend, Clara, had invited me to see her work. As we admired her intricate pottery, I noticed her wincing while adjusting a display. “Are you alright?” I asked, concerned.

Clara sighed. “It’s my thumb and wrist. The pain’s been unbearable, especially when I try to grip or twist something. Even holding my tools has become a struggle.”

As a doctor, her symptoms immediately raised a red flag. “Clara, it sounds like you might have De Quervain tendonitis,” I said gently. “Let’s sit down, and I’ll explain what’s happening.”

What Is De Quervain Tendonitis?

De Quervain tendonitis, also known as washerwoman’s sprain, is an inflammation of the tendons responsible for moving the thumb away from the hand. This condition, named after Swiss surgeon Fritz de Quervain, typically causes pain and swelling near the base of the thumb, making it difficult to grasp or pinch objects.

In Clara’s case, her pottery work involved constant repetitive thumb movements, which likely triggered the condition. This repetitive strain is a common cause of De Quervain tendonitis.

What Causes De Quervain Tendonitis?

The primary cause of De Quervain tendonitis is excessive friction and irritation of the abductor tendons of the thumb. These tendons run through a sheath at the wrist, and when irritated, they swell, causing pain and discomfort.

Common causes include:

• Repetitive hand movements: Activities such as knitting, gardening, or playing musical instruments can put strain on the tendons.
• Manual labor: Factory workers, carpenters, and others who perform repetitive tasks with their hands are at higher risk.
• Direct injury: Trauma to the thumb or wrist can cause inflammation.
• Hormonal changes: Pregnancy and menopause can make tendons more susceptible to swelling.

Research from the American Orthopaedic Society for Sports Medicine indicates that individuals who engage in repetitive thumb movements for over 4 hours daily have a 60% higher risk of developing tendon-related injuries.

Who Gets De Quervain Tendonitis?

De Quervain tendonitis can affect anyone but is more common in middle-aged individuals, particularly women between the ages of 40 and 50. According to a study published in the Journal of Hand Surgery, women are four times more likely to develop this condition than men, likely due to hormonal differences and occupational factors.

Occupational risk factors include:

• Factory workers: Repetitive tasks, such as using staplers or sewing machines.
• Musicians: Instruments that require precise hand movements.
• Caregivers: Lifting children or elderly individuals can strain the wrist.

What Are the Symptoms of De Quervain Tendonitis?

Clara’s symptoms matched the classic signs of De Quervain tendonitis, which include:

• Pain and swelling near the base of the thumb
• Difficulty gripping or pinching objects
• Pain that worsens with thumb movement or wrist twisting
• A catching or snapping sensation when moving the thumb
• Tenderness along the thumb side of the wrist

The American Journal of Orthopedics notes that the Finkelstein test is often used to diagnose De Quervain tendonitis. This test involves making a fist with the thumb tucked inside the fingers and then bending the wrist towards the little finger. If this motion causes pain, it is a strong indicator of De Quervain tendonitis.

How Is De Quervain Tendonitis Diagnosed?

Diagnosis is primarily based on the patient’s symptoms and physical examination. In some cases, ultrasound imaging can help confirm the diagnosis by showing swelling of the tendons.

The Finkelstein test remains the gold standard for diagnosing this condition. It’s a simple yet effective way to assess the severity of the inflammation.

What Are the Risks of De Quervain Tendonitis?

If left untreated, De Quervain tendonitis can lead to chronic pain and reduced hand function. The risks include:

• Permanent tendon damage
• Reduced grip strength
• Difficulty performing everyday tasks
• Chronic inflammation

A study published in the British Medical Journal found that individuals with untreated De Quervain tendonitis experienced a 30% reduction in hand strength after one year.

What Is the Treatment for De Quervain Tendonitis?

Fortunately, there are several treatment options available:

1. Rest and Activity Modification

Avoid activities that aggravate the condition. Resting the thumb and wrist can reduce inflammation.

2. Splints

Wearing a thumb splint can immobilize the affected area and promote healing. Splints are particularly effective when worn at night.

3. Anti-Inflammatory Medication

Over-the-counter painkillers like ibuprofen can help reduce pain and swelling.

4. Cortisone Injections

In more severe cases, a cortisone injection can provide relief by reducing inflammation around the tendons.

5. Physical Therapy

A physiotherapist can guide patients through exercises to improve flexibility and strength in the wrist and thumb.

6. Surgery

In rare cases where conservative treatments fail, surgery may be necessary. The procedure involves releasing the sheath around the tendons to reduce pressure.

Preventing De Quervain Tendonitis

Prevention is key, especially for individuals at high risk. Here are some tips:

• Take frequent breaks from repetitive hand movements.
• Use ergonomic tools to reduce strain on the wrist.
• Perform hand and wrist stretches regularly.

FAQs About De Quervain Tendonitis