De Quervain's Tenosynovitis

What is De Quervain's tenosynovitis?

Two tendons move the thumb away from the hand: the abductor pollicis longus, which pulls it out to the side, and the extensor pollicis brevis, which straightens it.

Near the wrist they run side by side through a narrow tunnel called the first dorsal compartment, lined by a slippery sheath so they can glide. When that sheath thickens and swells, the tendons no longer slide freely, and the rubbing causes pain.

The pain sits on the thumb side of the wrist, about an inch above the crease. It is worse when you lift with the thumb pointed up, wring out a cloth, turn a key, or lift a child under the arms. The spot is often swollen and tender to press.

It shows up often in new parents, because lifting a baby loads these tendons in the very position that hurts, many times a day. It is also seen in and after pregnancy, after a change in work or hobby, and in rheumatoid arthritis. Often no cause is found. A page cannot tell you which of these you have. Arthritis at the thumb base and an unsettled wrist fracture hurt in the same place.

How is De Quervain's tenosynovitis diagnosed?

The story and the exam carry most of it.

In the Finkelstein test, the examiner holds the thumb and bends the wrist toward the little finger. In the Eichhoff test, you tuck the thumb into the palm, close the fingers over it, and the wrist is bent the same way. Sharp pain over the first dorsal compartment is a positive result. The two names are often used for each other.

Imaging is usually not needed. An X-ray is taken when arthritis at the thumb base or an old fracture is possible. Ultrasound can show a thickened sheath, and whether the extensor pollicis brevis sits in its own side tunnel, which can make an injection less likely to work.

What is recovery like?

With a splint and changes to activity, symptoms often ease over several weeks.

After a steroid injection, relief usually begins within a few days to two weeks. According to general guidance from the American Society for Surgery of the Hand, most people improve after one or two injections, and symptoms return later for some. After a release, the hand is used lightly within days, and comfortable full use commonly returns over six to eight weeks. These are ranges, not promises.