Indian mythologyalways provokes deep thoughts and every string of words leaves us with complex range of interpretations. One such story is from The Mahabharata – ‘The Ekalavya’ which is again quite touching. He offered his thumb of his right hand as a fee (Gurudhakshina) to his worshiped guru, even after knowing that he could not perform archery without it. Not only Archery, but majority of our regular activities we perform, involves our thumb.

DeQuervain’s tenosynovitis is a painful condition that affects the functionality of our wrist and thumb due to the swelling of the tendons.Tendons are fibrous tissues that attach the muscles to bone. Actions like gripping, grasping, pinching or writing involves in the movement of the tendons present in the wrist and lower thumb to glide smoothly through a small tunnel that connects them to the base of the thumb. Repetitive activities cause swelling in these tendons and in turn lead to inflammation of the sheaths covering them. This can restrict their movement and also leads to pain and numbness in the affected region due to increased pressure on the surrounding nerves. In some patients the severity may enough to effect their activities of daily living.

What are the symptoms of de Quervain’s tenosynovitis?

The typical symptoms of de Quervain’s tenosynovitis are pain and tenderness at the bottom of the thumb. The pain may start suddenly, however it usually develops gradually and may worsen with time. Sometimes the pain may also radiateto the backof your forearm or thumb. Repetitive activities involving your wrists, hand or thumb may aggravate the symptoms.

Other symptoms may include:

• Swelling at the base of your thumb or on the side of your wrist
• Numbness on the back of your thumb and index finger
• Difficulty in moving your thumb or wrist (especially grasping or pinching)
• A squeaking sound while your tendons move in the swollen sheaths
• Formation of fluid-filled cysts at the swollen region

What are the causes of de Quervain’s tenosynovitis?

The common cause for de Quervain’s tenosynovitis is chronic overuse. Performing activities that involve repetitive movements can lead to irritation and pain. Some of the common movements that cause the condition include lifting a heavy grocery bag by their handles or lifting a child.

The following factors may increase your risk for developing the condition.

• Aged above 40
• Being a woman
• Injury or trauma to your wrist
• Inflammatory arthritis
• Pregnancy
• Engaging in certain games or activities that require repetitive movements

How is de Quervain’s tenosynovitis diagnosed?

The diagnosis usually involves examining your hand to check if you develop pain when pressure is applied on the thumb side of the wrist. A simple test known as Finkelstein test is useful in determining the condition; it involves bending your thumb across your palm of your hand and bending your fingers down closing your fingers to make a fist. Later bend your wrist towards your little finger. In this position your tendons are stretched and if this action creates pain on the thumb side of your wrist, you are likely to have de Quervain's tenosynovitis.

What is the treatment approach for de Quervain’s tenosynovitis?

The primary goal of the treatment is providing relief from the pain caused due to irritation and swelling. There are many options available for managing the symptoms. Some of them include:

Rest: Giving ample rest to your thumb is crucial as sometimes the symptoms may go away on their own while under rest. Continuing the activities that involve your thumb can further aggravate inflammation and pain.

Ice: Applying ice on the affected area also helps in providing relief.

Splint:You can use splints that extend over your thumb and wrist to restrict their movement and provide rest. Some doctors may suggest using them continuously for four to six months, while others may recommend wearing them only as required (during pain).

Medications: Oral administration of drugs such as non-steroidal anti-inflammatory drug (NSAIDs) help provide relief from inflammation.

Injections: If there is no considerable improvement of the condition, the physician may recommend steroid injections (corticosteroid) directly injected into the tendon sheath. Majority of people experience reduced swelling and better recovery after receiving injections.

Surgery: When all the above options fail in providing relief or when the symptoms are severe, surgery may be recommended. It involves excising the sheath that is surrounding your tendons and opening it to release pressure on the tendons or to create space for them to glide freely.

Consulting a physical therapist post-surgery helps in complete recovery. He may suggest muscle strengthening exercises for your wrist, arm and hand. He may also suggest on how to reduce stress on your wrist and how to alter your activities in order to limit tendon irritation.

Outlook

The outlook for the condition is good with early diagnosis and management. Usually using a splint and avoiding movements that irritate your tendons helps in management in majority of cases. If surgery is considered, recovery may take a few weeks. Following stretching and muscle strengthening exercises with professional advice helps in better recovery and regain complete functional joints.