2 weeks Ago By Mercura Wang
Commonly known as gamer’s thumb or mother’s wrist, De Quervain’s tenosynovitis—also called De Quervain’s syndrome or De Quervain’s disease—is a painful condition that affects the tendons on the thumb side of the wrist. It occurs when tendon entrapment affects the first dorsal compartment of the wrist causing the sheath covering these tendons to become thick and inflamed, making it painful to move the thumb or wrist. De Quervain’s disease, named after Swiss surgeon Fritz de Quervain, affects about 1 percent of the U.
S. population and peaks in people between the ages of 40 and 50. Type I: Characterized by a thickening and tight constriction of the APL and EPB tendons by a loop-shaped retinaculum or connective tissue, with no separation between them.
Type II: The retinaculum compresses only the EPB, leaving a clear separation. The exact cause of dQD isn’t fully understood. It is believed to result from irreversible tissue degeneration, where mucin—a type of protein made of glycosaminoglycans—accumulates within the fibers.
This occurs along with the formation of fibrous tissue deposits and increased blood vessel growth, rather than from acute inflammation of the synovial lining. These changes cause thickening of the tendon sheath on the thumb side of the wrist, which narrows the tunnel through which the tendons slide. As a result, the APL and EPB tendons get trapped, making movement difficult and leading to pain and tendon inflammation, especially during hand use.
Carpal Tunnel Syndrome: Symptoms, Causes, Treatments, and Natural Approaches Fibromyalgia: Symptoms, Causes, Treatments, and Natural Approaches Risk Factors Repetitive hand movements: Performing repeated wrist and thumb motions may lead to inflammation and progressive narrowing of the tendon tunnel Overuse of wrist and thumb: Prolonged overuse can result in chronic tendon injuries over time Acute wrist injury: A fall or impact may cause scar tissue to form, limiting tendon movement Inflammatory conditions: Conditions such as rheumatoid arthritis or diabetes, which cause swelling and pain, can contribute to tendon inflammation Anatomical differences in the wrist: Features like extra compartments in the tendon sheath or multiple tendon branches in the thumb muscles may increase the risk of dQD Additional Risk Factors Sex: dQD is several times more common in women than in men Age: dQD is more common between ages 40 and 59, though it can occur at any age Childbirth: The largest group of dQD patients are women with young babies, especially those who are breastfeeding. It typically develops four to six weeks after childbirth. While the cause is unclear, it may be related to hormonal changes or the physical strain of lifting and feeding the baby.
Symptoms usually resolve once a mother lifts her child less frequently Aromatase inhibitor therapy: Patients receiving this treatment for breast cancer may be at increased risk Pregnancy: Hormonal fluctuations during pregnancy and postpartum can cause fluid retention and swelling in the tissues, including the tendon sheaths in the wrist Certain sports: Activities such as tennis, racquetball, squash, and skiing involve repetitive, forceful movements that stress the thumb and wrist Pain: The primary symptom is pain on the thumb side of the wrist, which may develop gradually or suddenly. The pain often starts in the wrist and can extend up the forearm, worsening with activities such as grasping, lifting, using scissors, turning a door handle, gaming, or twisting the wrist. The pain may be sharp or dull.
Swelling: The thumb side of the wrist may become puffy or inflamed and can sometimes develop a fluid-filled cyst—a small sac of tissue in the area. Catching sensation: A catching or snapping feeling may occur when moving the thumb. Some people hear a strange sound, such as a squeak, crackle, snap, or creak, when moving the wrist or thumb.
Stiffness: Pain and swelling can make it challenging to move the thumb and wrist. Tenderness: The area just above the bony bump on the wrist may be sore to the touch due to irritated tendons. Numbness: The back of the thumb and index finger may feel numb.
Small bump: A small bump may develop on the thumb side of the wrist. 1. Medical History 2.
Physical Exam 3. Imaging Tests For persistent symptoms, treatment aims to relieve pain and swelling, maintain wrist function, and prevent recurrence. Recovery time varies by person.
Tier I: Conservative Management Patient education: Avoid repetitive or strain-inducing movements Rest: Limit wrist and thumb movements, avoiding activities that worsen symptoms Cold/heat therapy: Apply ice for 20 minutes every four hours or heat for 15 minutes every four to six hours Kinesiotaping: Can help reduce pain and swelling, support movement, and provide stability Nonsteroidal anti-inflammatory drugs: Reduce swelling and relieve pain Thumb splinting: May provide temporary relief, but recurrence rates are high, and patient compliance is often low Immobilization: Wearing a rigid splint to keep the wrist still can help relieve pain for people with mild symptoms Physical therapy or exercises: Stretch, strengthen, and increase the range of motion in the wrist and thumb. Following the splinting period, if symptoms have significantly improved, a hand therapist may recommend an exercise program, including assisted thumb extension, abduction, and wrist deviation; active thumb extension and abduction; and isometric wrist holds, thumb strengthening, and resisted wrist deviation Occupational therapy: Learning to perform tasks with a splint Therapeutic ultrasound: Used to treat inflamed tendons Extracorporeal shockwave therapy: A noninvasive procedure that uses sound waves to promote healing Transcutaneous electrical nerve stimulation: Uses mild electrical currents for pain relief Tier II: Corticosteroid Injections Tier III: Surgery Worsened symptoms: Without treatment, pain and other symptoms may persist or worsen. Over time, dQD can become chronic, making it difficult to use the wrist and thumb for everyday activities.
Permanently limited movements: The progressive and chronic nature of the inflammation can lead to lasting restrictions in wrist and thumb mobility. Tendon sheath bursting: Untreated inflammation leads to a continuous narrowing of the tendon sheath, increasing friction between the tendons and the sheath during movement. This constant friction can cause the tendons to degenerate and weaken, leading to tears in the tendon fibers.
Nerve injury or damage, causing numbness and tenderness Tendon entrapment or dislocation Wound complications, like swelling, bruising, bleeding, or infection Scarring Stiffness Complex regional pain syndrome Abnormal tendon movement Conversely, negative thinking or anxiety can increase stress, which may exacerbate inflammation and slow healing. A mindset focused on self-efficacy—believing in one’s ability to manage their condition—encourages a proactive approach to treatment. In contrast, a sense of helplessness may result in passive management and an increased risk of chronic issues.
Ayurvedic Management Massage Therapy Acupuncture Moxibustion Avoid repetitive movements: Minimize repetitive wrist movements and modify actions to reduce stress. Also, ensure correct technique when performing repetitive hand and wrist movements to avoid strain. Take breaks: Avoid overuse by taking frequent breaks during activities involving repetitive thumb movements.
Strengthen forearms: Strengthening forearm muscles improves wrist stability and reduces stress on tendons. Wear a brace or splint: If necessary, use a splint or brace to support the thumb and wrist. Follow recommended exercises: Perform exercises suggested by a physical therapist to stretch the thumb and wrist and relieve pressure.
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