DeQuervain’s tenosynovitis

Overview

Pain and tenderness on the thumb side of your wrist may be due to de Quervain’s tenosynovitis.  Tendons connect muscles to bone. Two of the tendons that move your thumb run along the thumb side of your wrist. As with all tendons, they usually glide smoothly through a covering called a tendon sheath. But when the tendon sheath gets swollen, the gliding isn’t so smooth and movement of your thumb and wrist becomes painful. In general, this condition is called tenosynovitis, or tendinosis. Swiss surgeon Fritz de Quervain was the first to describe it in this location.

Repetitive gripping with your hand and bending of your wrist is thought to be the cause of de Quervain’s tenosynovitis. This can happen in racket sports, such as tennis or racquetball, golf, or any activity where you grip with your hand and bend your wrist over and over again, such as lifting a child. It also can occur from repetitive blows to the area, such as when bumping a volleyball with improper technique.

Since overuse is the likely cause of the condition, the first principle of treatment is to rest the painful tendons. This can be accomplished by stopping the activities that make it hurt, or by wearing a splint that supports the wrist and thumb. Ice massage (six minutes three to four times per day) over the area and anti-inflammatory medicine (ibuprofen, naproxen, and others) may help ease pain. If pain continues, you should seek care from a sports medicine physician. Additional treatments that may help this problem include corticosteroid injections or surgery. 

Hand and wrist fractures are very common and encompass a range of injuries where there is a break or crack in one or more of the bones of your wrist. The most common of these injuries occurs in the wrist (distal radius fracture) when people try to catch themselves during a fall and land hard on an outstretched hand. Other common hand and wrist fractures include a scaphoid fracture (one of the eight bones in your wrist), metacarpal fracture, or phalangeal fracture (the small bones in your finger).

You may be at higher risk of a broken bone in your hand and wrist if you participate in sports like in-line skating or snowboarding, or if you have a condition in which bones become thinner and more fragile (osteoporosis).

It’s important to treat a broken bone as soon as possible. Otherwise, the bones might not heal in proper alignment, which might affect your ability to do everyday activities, such as writing or buttoning a shirt. Early treatment will also help minimize pain and stiffness.

A broken bone in the hand and wrist might cause these signs and symptoms:

  • Severe pain that might worsen when gripping or squeezing or moving your hand or wrist
  • Swelling
  • Tenderness
  • Bruising
  • Obvious deformity, such as a bent wrist

The diagnosis of a broken bone in your hand or wrist generally includes a physical exam of the affected hand and X-rays.

Sometimes, other imaging tests can give your doctor more detail. They are:

  • CT scan. CT scans can uncover fractures that X-rays miss. Injuries to soft tissues and blood vessels can be seen on CT scans. This technology takes X-rays from a variety of angles and combines them to depict cross-sectional slices of your body’s internal structures
  • MRI. Using radio waves and a powerful magnet to produce detailed images of bone and soft tissues, MRIs are much more sensitive than X-rays and can identify very small fractures and ligament injuries

If the broken ends of the bone aren’t aligned properly, there can be gaps between the pieces of bone or fragments might overlap. Your doctor will need to manipulate the pieces back into position, a procedure known as a reduction. Depending on the amount of pain and swelling you have, you might need a local or general anesthetic before this procedure. Whatever your treatment, it’s important to move your uninjured fingers regularly while the fracture is healing to keep them from stiffening. Ask your doctor about the best ways to move them. If you smoke, quit. Smoking can delay or prevent bone healing.

Immobilization

Restricting the movement of a broken bone in your hand and wrist is critical to proper healing. To do this, you’ll likely need a splint or a cast. You’ll be advised to keep your hand above your elbow as much as possible to reduce swelling and pain.

Medications

To reduce pain, your doctor might recommend an over-the-counter pain reliever. Narcotic medication such as codeine is rarely needed. NSAIDs can help with pain but might also hamper bone healing, especially if used long term. Ask your doctor if you can take them for pain relief.

If you have an open fracture, in which you have a wound or break in the skin near the wound site, you’ll likely be given an antibiotic to prevent infection that could reach the bone.

Hand therapy

After your cast or splint is removed, you’ll likely need rehabilitation exercises or hand therapy to reduce stiffness and restore movement in your wrist. Rehabilitation can help, but it can take several months or longer for complete healing.

Surgical and other procedures

Even after reduction and immobilization with a cast or splint, your bones can shift. So your doctor likely will monitor your progress with X-rays. If your bones move, you might then need surgery, which can take the forms of:

  •  Closed reduction and pinning. During this process, the fracture will be aligned and temporarily held by pins until the fracture has healed after which the pins are removed.
  • External fixation of the wrist. With external fixation, a metal frame outside your body immobilizes the fracture with two or more pins that pass through your skin and into the bone on either side of the fracture. This will be removed once the fracture has healed.
  • Open reduction and internal fixation. You might need surgery to implant pins, plates, rods, or screws to hold your bones in place while they heal. A bone graft might be used to help healing.

These options might be necessary if you have:

  • An open fracture
  • A fracture in which the bone pieces move before they heal
  • Loose bone fragments that could enter a joint
  • Damage to the surrounding ligaments, nerves, or blood vessels
  • Fractures that extend into a joint

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