When a tendon (a fibrous, non-elastic band of tissue which attaches a muscle to a bone) and its surrounding soft tissue (called the tenosynovium) are injured—either by a direct injury or due to micro-trauma like excessive repetitive movements—they become inflamed, swollen, and painful. This condition is called Tenosynovitis. (A less accurate and rarely used term to describe this condition is tendonitis.)
While all of the tendons of the wrist and hand may become inflamed and painful, the most common form of tenosynovitis seen in the hand and wrist is called deQuervain's Tenosynovitis. deQuervain's Tenosynovitis affects the thumb and wrist.
Anatomy: deQuervain's Tenosynovitis affects two thumb tendons: the abductor pollicis longus (APL) and the extensor pollicis brevis (EPB). These tendons connect their respective muscles, which lie on the back of the forearm, to the thumb. These tendons are responsible for extending the thumb backwards, and for moving the thumb away from the palm of the hand.
On their way to the thumb, the APL and EPB travel side-by-side along the inside of the wrist. They pass through a tunnel in the wrist which is covered by a non-elastic type of fibrous tissue called the Extensor Retinaculum. The function of this tunnel is to hold the tendons in place.
Pathology: Normally, the APL and EPB glide easily back and forth within this tunnel as they move the thumb. When the APL and EPB become inflamed and swollen, however, the tendons become compressed against each other because the Extensor Retinaculum (the non-elastic band of tissue that covers the tunnel) cannot expand to "make more room for the swollen tendons." This leads to restricted and painful tendon and thumb movements.
Causes: The most common cause of deQuervain's Tenosynovitis involves repetitive thumb movements such as grasping, pinching, squeezing, or wringing. When we "overdo" these movements, the APL and EPB become inflamed, and this leads to swelling. This swelling hampers the smooth gliding action of these tendons within the tunnel, thus producing pain. Other causes may include:
- trauma to the APL and EPB, such as straining these tendons due to a fall.
- arthritic diseases, such as rheumatoid arthritis.
- scar tissue from surgery or an injury can make it difficult for the tendons to slide easily through the tunnel.
Symptoms: At first, the only symptom one may experience is soreness on the thumb side of the wrist. As the inflammation and swelling of the APL and EPB increases, due to continued repetitive thumb movements, one may also begin to experience:
1. pain with these thumb movements:
a. lifting the thumb away from the palm
b. making a fist
c. moving the wrist towards the little finger
d. grasping a lid and squeezing it while trying to turn and open it
2. "squeaking noise" as the two tendons rub against each other in the tunnel, with movement of the thumb. This noise is known as crepitus.
If the condition is allowed to become worse, pain may begin to radiate from the inner side of the wrist into the thumb and up the forearm.
Diagnosis: The diagnosis of deQuervain's Tenosynovitis is made using a simple test called the Finkelstein Test. To perform this test on yourself one only needs to:
1. bend your thumb into the palm of your hand;
2. close your fingers over your thumb (make a fist);
3. finally, bend your wrist away from the thumb, towards your small finger
If you feel pain over the tendons to the thumb (the APL and the EPB), in the wrist, and/or thumb, you may be experiencing deQuervain's tenosynovitis.
Treatment: The "Gold Standard" of medical care (the treatment used by most physicians and therapists) involves limiting thumb motion and maintaining the wrist in a neutral alignment. In other words, keep the wrist in a straight line with your arm, without bending it forwards or backwards. This is best accomplished by using our thumb-wrist brace which will keep the wrist and lower joints of the thumb from moving, but will allow full finger dexterity. This brace is comfortable, and will allow you to continue most of your daily activities, while allowing the thumb, wrist, and tendons to heal. Click here for more information about this effective brace.
Other self-help treatments include:
1. avoid repetitive hand motions, such as twisting the wrist, grasping, and wringing
2. applications of ice on the thumb, wrist, and lower forearm for 20-30 minutes at a time. Do not "freeze" the area, just maintain a comfortable cooling temperature. Ice, can easily be combined with support when you use our Active Wrap Hot/Cold Therapy Wrist Wrap. This brace will not only provide your painful thumb with soothing cold, but it will gently cradle and protect it from further injury. If ice increases the pain, stop immediately. Cooling the tendons will usually decrease swelling, inflammation, and pain.