De Quervain’s Tenosynovitis : Symptoms, Treatment, Splints

How and why do we get this tendinitis?

First, it’s important to know that the tendons involved in De Quervain’s tendinitis pass through a kind of tunnel at the wrist.

Here’s how it’s thought to happen:

• By using the wrist or thumb extensively in any activity, we can gradually damage this tunnel.
• The tunnel becomes inflamed, and the lining around it thickens over time.
• As a result, the space available for the tendons decreases.
• When these tendons are used, the increased friction within the narrowed tunnel causes pain to develop.

It is worth noting that the risk of developing this tendinitis increases with age and among women (genetic factors).

Recognizing De Quervain’s Tendinitis: What are the Symptoms?

Symptoms are:

1️⃣ History of overuse of the affected wrist and thumb, whether in a professional, sports, or artistic context.

Carrying a baby is also a typical activity that can lead to De Quervain’s tendinitis.

2️⃣ Activity-related pain:

▪️ Isolated pain without other abnormalities, such as swelling of the wrist;

▪️ Located at the wrist, on the thumb side;

▪️ Can be elicited through specific tests. The Finkelstein test is likely the best available:

You are asked to bend your wrist as far as your pain allows (bending in the direction indicated by your palm);

At the same time, you are asked to extend and stretch your thumb backward as much as possible (backward as indicated by the back of your hand).

An examiner applies gradual pressure to move your thumb closer to your other fingers. You should resist.

The test is positive if there is pain with moderate pressure.

3️⃣ Tenderness upon palpation of the painful area during activity.

4️⃣ Sometimes, slight localized swelling in the same painful area.

“Activity-related pain” is distinct from “resting pain,” which occurs even without movement.

Note: Following or during a period of intense activity, De Quervain’s tendinitis can transiently cause resting pain.

Sources: Goubeau, 2013; Millar, 2021

Is an X-ray, ultrasound, or MRI necessary?

Getting an X-ray, ultrasound, or MRI is not necessary to diagnose De Quervain’s tendinitis.

However, these imaging techniques can be useful for:

⚫ Ensuring there is no other problem that would require a different approach than that of De Quervain’s tendinitis (see next section);

⚫ In cases of highly disabling and persistent tendinitis, accurately identifying anatomical details of the painful area:

both to guide potential injection or surgical treatment; but also to estimate the chances of improvement in the situation (prognosis).

Sources: Goubeau, 2013; Goyal, 2018; Millar, 2021

What should de Quervain’s tenosynovitis not be confused with?

Wrist pain can be explained by a large number of causes other than de Quervain’s tenosynovitis. Ruling out these causes is an important step in diagnosis.

What are these causes? They include:

🟥 Red flags, meaning problems that require urgent management such as:

▪️ Traumas like fractures or dislocations;

▪️ Septic arthritis (joint infection);

▪️ Malignant tumors (cancer).

🟨 Systemic (global) issues, less urgent than the former but still requiring prompt management:

▪️ Rheumatological diseases (e.g., psoriasis, rheumatoid arthritis, scleroderma, systemic lupus erythematosus);

▪️ Granulomatous diseases (e.g., sarcoidosis, tuberculosis);

▪️ Hematological diseases (e.g., leukemia, multiple myeloma);

▪️ Metabolic conditions (e.g., acromegaly, diabetes, gout, hyperparathyroidism, hypocalcemia, hypothyroidism, Paget’s disease, pregnancy, pseudogout);

▪️ Amyloidosis;

▪️ Osteomyelitis;

▪️ Peripheral neuropathies.

All these diseases or conditions can lead to wrist pain (among other symptoms).

⬛ Other issues such as:

▪️ Sequelae of old fractures: nonunion of certain small wrist bones (scaphoid or hamate);

▪️ Avascular necrosis of certain small wrist bones (scaphoid or lunate);

▪️ Ligamentous injuries;

▪️ Triangular fibrocartilage complex injuries (a specific anatomical structure of the wrist);

▪️ Subluxations;

▪️ Carpal instability (a region of the wrist composed of 8 small bones);

▪️ Sequelae of ligamentous injuries;

▪️ Synovial effusion or cysts;

▪️ Nerve lesions and compressions:

Posterior interosseous nerve syndrome; Carpal tunnel syndrome; Ulnar nerve (or cubital) syndrome; Thoracobrachial outlet syndrome; ▪️ Intersection syndrome;

▪️ Complex regional pain syndrome.

Good news: if a professional suspects you have de Quervain’s tenosynovitis, it means they have ruled out everything else! (At least temporarily; mistakes can happen.)

Sources: Forman, 2005; Schmidt, 2021

What treatment for de Quervain’s tenosynovitis?

It is estimated that de Quervain’s tenosynovitis often resolves on its own [Philips, 2022]:

either by stopping the activities that caused and maintain the problem; or within one or two years maximum.

To potentially speed up recovery, there are both non-surgical and surgical approaches.

Non-surgical approaches

The initial treatment options for de Quervain’s tenosynovitis include:

modifying the activities that led to the tenosynovitis and aggravate it; temporarily wearing a splint (or orthosis) to immobilize the wrist and the base of the thumb; taking anti-inflammatory medications; administering corticosteroid injections.

Some also suggest:

performing certain exercises; applying ultrasound therapy; using adhesive elastic bandages.

How effective are these approaches?

Do they work? To what extent?

Unfortunately, in my opinion, there are not enough substantial and high-quality studies to answer these questions.

However, the limited literature on the subject suggests that the best strategy to date is:

1️⃣ first, consider modifying problematic activities, potentially wearing a splint, and possibly taking anti-inflammatory medications (under supervision).

2️⃣ Then wait, at least 6 weeks.

2️⃣ If the first step fails, consider one to two corticosteroid injections in addition to wearing a splint [Cavaleri, 2016].

3️⃣ If the second step fails, consider the surgical approach.

Sources: Fakoya, 2023; Rutkowski, 2023; Cavaleri, 2016; Philips, 2022

Surgical Approach

If the non-surgical approach fails (less than 10% of cases [Philips, 2022]), surgery may be considered.

The surgical approach involves making an incision in the tunnel through which the affected tendons pass. In other words, a small cut is made along its length.

This technique relieves pressure within the tunnel; similar to unbuttoning your pants after a hearty meal to feel more comfortable.

Following this type of surgery typically involves:

• wearing a splint for immobilization for one to two weeks;
• encouragement to perform exercises, initially without constraints, then with constraints (strengthening);
• advice on managing hand swelling (edema) and scar care.

How effective?

According to the literature on the subject, the outcomes of this type of surgery are good in the short and long term [Scheller, 2008; Lee, 2014].

However, like any surgery, there is a risk of complications. This is one of the reasons why this approach is always considered as a last resort.

Sources: Scheller, 2008; Lee, 2014; Philips, 2022

Splints (or orthoses) and de Quervain’s Tenosynovitis: Which One to Choose?

Here’s what you need to know about it:

✅ The principle of a splint for de Quervain’s tenosynovitis is to immobilize the wrist and the base of the thumb (see image 5).

✅ There are many types of splints available to relieve de Quervain’s tenosynovitis.

✅ There is no study that has demonstrated the superiority of one over another.

✅ Therefore, based on the previous point, any standard splint will do the job! (In the right size and adjusted to your comfort.) (See on Amazon)

***

Here’s what I wanted to tell you about this! I wish you a very good recovery! Do you have any comments or questions? Your comments are welcome 🙂 !

You may also like:

• Ultrasound therapy by physical therapist
• Common causes of wrist pain without swelling

 📚 SOURCES

Mattox R, Battaglia PJ, Scali F, Ottolini K, Kettner NW. Distal intersection syndrome progressing to extensor pollicis longus tendon rupture: a case report with sonographic findings. J Ultrasound. 2016 Dec 8;20(3):237-241. doi: 10.1007/s40477-016-0223-4. PMID: 28900524; PMCID: PMC5573695.

Wai-si, T. E., Joanne, Y., Yu, L. K., Lun, Y. K., Christian, F., & Pui, N. S. (2020). De Quervain’s Tenosynovitis: A Systematic and Citation Network Analysis Review. Biomedical Journal of Scientific & Technical Research, 24(5), 18674-18684. DOI: 10.26717/BJSTR.2020.24.004125

Goubau JF, Goubau L, Van Tongel A, Van Hoonacker P, Kerckhove D, Berghs B. The wrist hyperflexion and abduction of the thumb (WHAT) test: a more specific and sensitive test to diagnose de Quervain tenosynovitis than the Eichhoff’s Test. J Hand Surg Eur Vol. 2014 Mar;39(3):286-92. doi: 10.1177/1753193412475043. Epub 2013 Jan 22. PMID: 23340762.

Millar, N.L., Silbernagel, K.G., Thorborg, K. et al. Tendinopathy. Nat Rev Dis Primers 7, 1 (2021). https://doi.org/10.1038/s41572-020-00234-1

Goyal A, Srivastava DN, Ansari T. MRI in De Quervain Tenosynovitis: Is Making the Diagnosis Sufficient? AJR Am J Roentgenol. 2018 Mar;210(3):W133-W134. doi: 10.2214/AJR.17.19078. PMID: 29469625.

Forman TA, Forman SK, Rose NE. A clinical approach to diagnosing wrist pain. Am Fam Physician. 2005 Nov 1;72(9):1753-8. PMID: 16300037.

Schmidt E, Kobayashi Y, Gottschalk AW. It’s Not De Quervain Tenosynovitis – A Diagnosis to Consider in Persistent Wrist Pain. Ochsner J. 2021 Summer;21(2):120-122. doi: 10.31486/toj.21.0005. PMID: 34239368; PMCID: PMC8238112.

Fakoya AO, Tarzian M, Sabater EL, Burgos DM, Maldonado Marty GI. De Quervain’s Disease: A Discourse on Etiology, Diagnosis, and Treatment. Cureus. 2023 Apr 24;15(4):e38079. doi: 10.7759/cureus.38079. PMID: 37252462; PMCID: PMC10208847.

Rutkowski M., Rutkowski Kristy. Potential effects, diagnosis, and management of De Quervain Tenosynovitis in the aesthetics community: A Brief Review, Case Example, and Illustrative Exercises. J Clin Aestet Dermatol 2023;16(9 Suppl 2):S28-31.

Cavaleri R, Schabrun SM, Te M, Chipchase LS. Hand therapy versus corticosteroid injections in the treatment of de Quervain’s disease: A systematic review and meta-analysis. J Hand Ther. 2016 Jan-Mar;29(1):3-11. doi: 10.1016/j.jht.2015.10.004. Epub 2015 Nov 6. PMID: 26705671.

Philips M., The natural history of DeQuervain’s tenosynovitis, 2022, sportsortho.co.uk