One of the most common causes of thumb and wrist pain is due to tendonitis. DeQuervain’s tendonitis is a type of tendonitis which common in young mothers. This causes pain on the thumb side of the wrist. The pain is worse with movement of the thumb and wrist at the same time. Opening jars, turning door knobs, and caring for a young child can be difficult.
When there is irritation of the tendons in the wrist, the pain can occur. Normally tendons glide smoothly in the hand and wrist. In DeQuervain’s tendonitis, the tendons have friction around them and they become inflamed and painful. Patients feel pain in the thumb-side of the wrist. Certain movements of the thumb and wrist can be excruciating. Patients may see wrist swelling, or feel a tender bump in this area. Occasionally popping around the tendons is noticed by the patient.
The cause of DeQuervain’s tendonitis is usually unknown. Symptoms can start after a new, repetitive activity. The condition is common in females, especially pregnant women and mothers of young children. It has been called “mommy’s thumb” or “mommy’s wrist”.
DeQuervain’s tendonitis can be diagnosed by symptoms and examination in the doctor’s office. An x-ray can sometimes be helpful to rule-out other conditions, such as arthritis or wrist fracture.
Finkelstein’s test can help confirm the diagnosis. During this exam test, the patient places their thumb into their palm and wraps/clasps their fingers around the thumb. The patient then moves their wrist in the direction towards their small finger (take care, this can be very painful!).
Fortunately, most people improve with time and do not need surgery for DeQuervain’s tendonitis. Therefore, non-operative treatment is tried first. Treatment is focused on reducing pain, reducing inflammation, and improving hand function. Wearing a splint which supports and immobilizes the thumb and wrist (“thumb spica brace”) can help reduce symptoms. Off-the-shelf and custom-made braces are available. Resting the hand by avoiding repetitive thumb motion and forceful gripping may reduce the irritation. Anti-inflammatory medications such as Ibuprofen, Naproxen, and Tylenol can reduce pain. Topical gels can reduce pain and inflammation. Hand therapists can teach stretching exercises and reduce pain with modalities such as iontophoresis treatment. Adjusting the way you use your hand can help.
Many people can be cured with a cortisone shot or two. Corticosteroid injections are very effective in reducing or eliminating symptoms in approximately 80% of patients. The risks of corticosteroid injection (also called a “cortisone shot”) are pain, infection, skin color change, and rarely thinning of the skin at the injection site. Diabetics should be aware that blood sugars can be increased for a few days after a cortisone shot. Also multiple injections should be avoided as they can weaken the soft tissues over time.
- Topical medications
- Thumb spica brace
- Oral anti-inflammatory medications
- Hand Therapy
- Adjusting hand activities
- Steroid Injection
If these non-surgical treatments do not improve the symptoms, surgery may be recommended. DeQuervain’s release surgery is performed to improve the gliding of the tendons with the goal of reducing pain. During this procedure, the tight sheath (extensor retinaculum) is opened through a small incision on the thumb-side of the wrist. Results from this surgery are excellent in most cases. The recovery often takes about 6 weeks after surgery.