De Quervain's Tenosynovitis

The
Wrist

De Quervain's TSV is a painful condition affecting two tendons at the base of the thumb as they travel side by side along the inside of the wrist. They pass through a soft tissue channel or sheath, with the inner walls of the channel producing a slippery fluid to lubricate the tendons as they slide back and forth.

​Repetitive or excessive movements may cause the lubrication system to malfunction allowing friction to develop between the tendons of the thumb and the soft tissue sheath. The friction leads to thickening and constriction of the sheath, which interferes with the smooth gliding of the tendons.

Pain over the thumb side of the wrist is the main symptom, and this pain can also radiate down the thumb or up to the forearm. As the friction persists the tendons can start to 'squeak' as they move through the constriction, and is called crepitus. Other specialised tests can be performed by your physiotherapist to confirm the diagnosis, and an ultrasound scan can also provide additional confirmation.

Treatment initially consists of splinting to support the wrist and thumb and allow the tendons to rest and heal. Anti-inflammatory medications, massage, ultrasound and laser may be used to help control the swelling, and as the symptoms settle the splint may be taken off the do light pain-free activities as tolerated. Stretches for the thumb may also be introduced to ensure good glide of the affected tendons, as well as other conditioning exercises.

If symptoms persist, you doctor may suggest a cortisone injection into the irritated tunnel to reduce swelling of the tendons. If conservative measures do not provide a satisfactory outcome, surgery may be necessary.

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