De Quervain’s Stenosing Tenosynovitis (Wrist Pain)

Cure your Wrist Pain Today. Effective treatment, Non Surgery. Discuss with our Hand Specialist for the Diagnosis, Treatment and Prognosis of your Wrist Pain. Call us +65 97731458 to schedule for an appointment.

De Quervain’s tenosynovitis  is a painful condition affecting the tendons on the thumb side of your wrist. If you have de Quervain’s tenosynovitis, it will probably hurt every time you turn your wrist, grasp anything or make a fist.

Although the exact cause of de Quervain’s tenosynovitis isn’t known, any activity that relies on repetitive hand or wrist movement such as working in the garden, playing golf or racket sports or lifting your baby can make it worse.

Symptoms of de Quervain’s tenosynovitis include:

  • Pain near the base of your thumb
  • Swelling near the base of your thumb
  • Difficulty moving your thumb and wrist when you’re doing activities that involve grasping or pinching
  • A “sticking” or “stop-and-go” sensation in your thumb when trying to move it

If the condition goes too long without treatment, the pain may spread farther into your thumb, back into your forearm or both. Pinching, grasping and other movements of your thumb and wrist aggravate the pain.

When to see a doctor
Consult your doctor if you’re still having problems with pain or function and you’ve already tried:

  • Avoiding moving your thumb in the same way over and over again whenever possible
  • Avoiding pinching with your thumb when moving your wrist from side to side
  • Applying cold to the affected area
  • Using nonsteroidal anti-inflammatory drugs.

If the pain continues to interfere with your daily life or activities, seek medical advice.

Causes for De Quervain’s Tenosynovitis

Chronic overuse of your wrist is commonly associated with de Quervain’s tenosynovitis.

When you grip, grasp, clench, pinch or wring anything in your hand, you use two major tendons in your wrist and lower thumb. These tendons normally glide unhampered through the small tunnel that connects them to the base of the thumb. If you repeat a particular motion day after day, it may irritate the sheath around the two tendons, causing thickening that restricts the movement of the tendons.

Other causes of de Quervain’s tenosynovitis include:

  • Direct injury to your wrist or tendon; scar tissue can restrict movement of the tendons
  • Inflammatory arthritis, such as rheumatoid arthritis

If de Quervain’s tenosynovitis is left untreated, it may be hard to use your hand and wrist properly. If the affected tendons are no longer able to slide within their tunnel, you may develop a limited range of motion.

Tests and Diagnostic of the De Quervain Tenosynovitis

To diagnose de Quervain’s tenosynovitis, your doctor will examine your hand to see if you feel pain when pressure is applied on the thumb side of the wrist.

Your doctor will also perform a test called the Finkelstein test. In a Finkelstein test, you bend your thumb across the palm of your hand and bend your fingers down over your thumb. Then you bend your wrist toward your little finger. If this causes pain on the thumb side of your wrist, you likely have de Quervain’s tenosynovitis.

Imaging tests, such as X-rays, generally aren’t needed to diagnose de Quervain’s tenosynovitis.

Treatment for De Quervain’s Tenosynovitis

Treatment for de Quervain’s tenosynovitis may include medications, physical or occupational therapy, or surgery. Treatment is generally successful if begun early on, though the pain may recur if you can’t discontinue the repetitive motions that aggravate your condition. If you start treatment early on, your symptoms of de Quervain’s tenosynovitis should generally improve within four to six weeks. When de Quervain’s tenosynovitis starts during pregnancy, symptoms usually get better around the end of pregnancy or when breast-feeding stops.

Medications
To reduce pain and swelling, your doctor may recommend using non steroid anti-inflammatory injection.

Our doctor may also recommend injections into the tendon sheath to reduce swelling. If treatment begins within the first six months of symptoms, most people recover completely after receiving injections, often after just one injection.

Therapy
Initial treatment of de Quervain’s tenosynovitis may include:

  • Immobilizing your thumb and wrist, keeping them straight with a splint or brace to help rest your tendons
  • Avoiding repetitive thumb movements whenever possible
  • Avoiding pinching with your thumb when moving your wrist from side to side
  • Applying ice to the affected area

You may also see a physical or occupational therapist. These therapists may review your habits and give suggestions on how to make necessary adjustments to relieve stress on your wrists. Your therapist can also teach you exercises focused on your wrist, hand and arm to strengthen your muscles, reduce pain, and limit the irritation of the tendons. The therapist may also make a splint to keep your wrist and thumb from moving if off-the-shelf versions don’t fit you well.

Surgery
If your case is more serious, your doctor may recommend outpatient surgery. Surgery involves a procedure in which your doctor inspects the sheath surrounding the involved tendon or tendons, and then opens the sheath to release the pressure and restore free tendon gliding.

Our Doctor will talk to you about how to rest, strengthen and rehabilitate your body after surgery. A physical or occupational therapist may meet with you after surgery to teach you new strengthening exercises and help you adjust your daily routine to prevent future problems.

Cure your Wrist Pain Today. Effective treatment, Non Surgery. Discuss with our Hand Specialist for the Diagnosis, Treatment and Prognosis of your Wrist Pain. Call us +65 97731458 to schedule for an appointment.

Hand and Wrist Pain

Dr Ambrose Yung Knee, Sports and Orthopaedic Centre Knee, Sports and Orthopaedic Clinic

Stop your Hand & Wrist Pain today. Effective Treatment, Non Surgery. Discuss with our Orthopaedic Specialist for the Diagnosis, Treatment and Prognosis of your Hand Pain. Call us +65 97731458 to schedule for an appointment.

Hand and Wrist pain can be caused by one or more of a number of different disorders. Lifestyle diseases will become more common as we live longer and lead more active lives. Hand and wrist pain are among these lifestyle diseases. They are usually amenable to simple treatment strategies, provided they are diagnosed early.

Hand and Wrist Pain

Why are the hand and wrist special?
The hand and wrist are our main point of physical contact with the world. They manipulate objects to aid us in our daily lives. As such, pain that disables our hand and wrist can lead to a marked decrease in our ability to functional at work and play.

Which parts of our hand and wrist are commonly affected by pain?

– Hand pain
A common cause of hand pain that many feel at the base of their fingers, in the palm of the hand, is trigger finger. Trigger finger is a condition where a patient feels pain or discomfort when trying to straighten or bend their finger/thumb. Sometimes the finger may become ‘locked’ or ‘stuck’ when swelling of the tendon sheath occurs. This swelling can be associated with diabetes, rheumatoid arthritis, or even golf.

Carpal Tunnel Syndrome can also cause hand pain. There is a tunnel in the wrist called the carpal tunnel. Nine tendons and the median nerve pass through it. When pressure builds up in the tunnel, the nerve gets compressed and is unable to function properly. This may result in numbness, discomfort and pain in the fingers. This condition usually associated with a tingling sensation over the thumb, index and middle fingers, especially at night. Risk factors for carpal tunnel syndrome include age, diabetes and rheumatoid arthritis.
Another common cause of finger pain is trauma. In this instance, the injured tissue could be the tendon, ligament, bone, or even a combination. It is thus imperative that all injured tissues are adequeately addressed and optimally treated.

– Wrist Pain
Wrist pain is more complex. It is usually divided into conditions that cause pain on the radial side of the wrist, i.e. nearer the thumb, and those that cause pain on the ulnar side of the wrist, i.e nearer the little finger.

Radial-sided wrist pain
Radial-sided wrist pain can be caused by an injury to an important ligament called the scapholunate ligament. This ligament helps two important bones of the wrist joint, namely the scaphoid and the lunate, move in unison. When this ligament is injured, these bones no longer move in tandem, thus leading to pain. This would be aggravated by motion and lead to accelerated arthritis in the wrist, which in turn, manifests as stiffness and poor grip strength.

In addition, woman who are in the perinatal period also belong to a unique population who can suffer from a tendon condition called Dequervain’s Tenosynovitis. It is a condition in which one feels pain over the wrist joint near the base of the thumb. It begins as an aching sensation initially, and progresses to a point when any movement of the wrist or thumb produces sharp pain in the affected area. That area of the wrist may become swollen at times. Often, nursing mothers affected for the period that they are caring for their newborns. This is due to poor ergonomics, or by the hormonal changes that affect their tissues.

Ulnar sided wrist pain
Ulnar sided wrist pain is common in a patient who has sustained a twisting injury or a fall on an outstretched hand. This is usually due to a tear of a ligamentous structure called the “triangular fibrocartiligeneous complex”, which stabilises the wrist joint. Patients with this problem can experience pain in their wrists associated with instability and diminished grip strength. Like the radial side of the wrist, tendons on the side of the wrist can also suffer from inflammation which causes pain, and is usually caused by overuse.

How do we diagnose such conditions?
Firstly, we take a history from our patients. This includes finding out the circumtance surrounding their complaint, as well as the nature of the complaint. This can help us ascertain the tissue that is the main “pain generator”.
Secondly, a thorough clinical examination of the hand and wrist helps us confirm or rule out the possible reasons for our patient’s pain.
X-ray, fluoroscopy (real time X-rays), computed tomograpgy (CT) scans and magnetic resonance imaging (MRI) scans are all important diagnostic tools to help Hand Surgeons confirm diagnoses.

Arthroscopy of the wrist is currently the gold standard diagnostic procedure of choice when the internal architecture of the joint, such as the cartilage, needs to be assessed. Therapeutic key-hole surgery can also be performed with the aid of this tool.

Most common causes of Hand and Wrist discomfort includes:

  • CARPAL TUNNEL SYNDROME – Carpal tunnel syndrome occurs when the median nerve which runs from the forearm into the hand becomes pressed or squeezed at the wrist.
  • DE QUERVAIN’S STENOSING TENOSYNOVITIS – is a condition brought by irritation or inflammation of the wrist tendons at the base of the thumb.
  • MALLET FINGER – Mallet finger occurs when the outermost joint of the finger is injured. With mallet finger, the tendon on the back of the finger is separated from the muscles it connects.
  • TRIGGER FINGER – Trigger finger is a common disorder of the hand which causes painful snapping or locking of the fingers or thumb.
  • ARTHRITIS – Osteoarthritis of the fingers and thumb is characterized as chronic and often disabling pain and stiffness of one or more joints.
  • HEBERDEN’S NODES – are hard or bony swellings that can develop in the distal interphalangeal joints (DIP) (the joints closest to the end of the fingers and toes).
  • WRIST GANGLION CYST – is a swelling that usually occurs over the back of the hand or wrist. These are benign, fluid-filled capsules.

Stop your Hand & Wrist Pain today. Effective Treatment, Non Surgery. Discuss with our Orthopaedic Specialist for the Diagnosis, Treatment and Prognosis of your Hand Pain. Call us +65 97731458 to schedule for an appointment.