What is De Quervain’s Disease?
De Quervain’s disease is a condition that affects the tendons on the side of the thumb of the wrist. People having De Quervain’s disease experience pain when they try to turn their wrist. It actually causes pain when a person moves their wrist and the swollen tendon rub against the narrow tunnel that they pass through. It mainly causes pain in the lower arm at the base of the thumb. Due to this problem, the person feels severe pain while working in the garden, lifting a baby, playing golf or playing racket sports. It is seen that this disease can happen to an adult who aged in between 30 to 50 years. It also happens 8 to 10 time more in women than that of the men. It mainly occurs in women after pregnancy when they repeatedly lift their newborn baby (1). The condition of De Quervain’s disease gets worse when a person moves their wrist over and over again no matter whether it is for fun or work.
Symptoms of De Quervain’s Disease
The person having De Quervain’s disease will experience the following symptoms:
- Pain at the base of the thumb
- Swelling at the base of the thumb
- Difficulty in moving the wrist and thumb
The pain may start suddenly and gradually increase from the thumb to the forearm. The pain will get worse when you move your thumb or wrist.
Causes of De Quervain’s Disease
Tendon is a type of rope-like structure which is attached the muscles to the bone (1). When a person grips, clenches or grasps something with their hand, two tendons that exist in the wrist and lower thumb usually glide efficiently with the small tunnel. When a specific motion is repeated again and again the sheath around both the tendon of the wrist causes swelling as well as thickening. Due to this reason, the movement of the wrist gets restricted. Apart from this injury in wrist or tendon may also cause De Quervain’s disease due to which scar tissue restricts the movement of the tissue. Moreover, sometimes De Quervain’s disease is also caused due to inflammatory arthritis or rheumatoid arthritis.
Diagnosis of De Quervain’s Disease
For examining De Quervain’s disease in patient doctors may apply pressure on the thumb side of their wrist and checks if they feel pain. Apart from that, the doctors may also ask you to go for the Finkelstein test (2). It is a kind of test in which the patient is asked to bend the thumb across his palm and then slowly bend his fingers down over the thumb. After that, the patient needs to bend their wrist towards their little finger. If the patient feels pain in such condition then the doctors assume that the patient has De Quervain’s disease.
Treatment for De Quervain’s Disease
If you start the treatment at the initial period then there are chances that you get relief from De Quervain’s disease within four to six weeks. However, when symptoms of De Quervain’s disease start during the pregnancy it is observed that the patient gets relief after the end of the pregnancy or during the breastfeeding. The problem of De Quervain’s disease can be treated with –
Doctors mainly prescribe medication such as ibuprofen (Advil, Motrin IB, etc.) and Naproxen (Aleve) for reducing the pain as well as swelling. Sometimes doctors may also prescribe an injection of corticosteroid medications. The injection is generally given to the sheath for reducing the swelling. In case the treatment stars within the six months of the symptoms then the patient gets completely relieved.
The therapist may suggest you do the following therapy during the initial stage:
- Immobilize both the thumb and wrist while keeping them straight with a splint
- Avoid the movement of the thumb as far as possible
- Avoid pinching with the thumb at the time when you move the wrist side by side
- Apply ice in the affected area
Apart from the above therapies the therapist also suggests you exercise for the wrist, hand as well as arms so that you can strengthen your muscles, limit the irritation of tendon and reduce the pain.
In severe condition, the doctors may advise you to go for surgery. In this process of surgery, the surgeon opens the sheath that surrounds the tendon and releases the pressure. Once the pressure is released the tendon can glide freely. Once the surgery is over you have to follow the advice of the surgeon about how to rest and strengthen your tendon and rehabilitate your body.
If you observe hand or wrist related pain or any other symptoms of De Quervain’s disease then you should go to the doctor and check your condition. However, your doctor may refer you to an orthopedic, rheumatologist, hand therapist or therapist for proper treatment. They will first examine to determine if you have developed De Quervain’s disease and if you have this disease then they will advise you to start the required therapy immediately. In most cases, it is seen that the problem gets relieved after continuing physical therapy for 6 to 8 weeks.
- © 2017 American Society for Surgery of the Hand
- Shiel WC Jr., De Quervain’s Tenosynovitis,