De Quervain's tenosynovitis

De Quervain tenosynovitis is an entrapment tendinitis of the tendons contained within the first dorsal compartment at the wrist. It is an inflammatory condition affecting the tendon sheaths (tenosynovitis) that pass over the wrist joint. The inflammatory response occurs following injury and leads to the symptoms of pain, heat, redness, swelling and loss of function. This is particularly noticeable when forming a fist, grasping or gripping things, or when turning the wrist.
Also known as:
Radial styloid tenosynovitis
de Quervain disease

de Quervain's stenosing tenosynovitis
mother's wrist and mommy thumb
washerwoman's sprain
De Quervain's tenosynovitis (duh-kare-VAHS ten-oh-sine-oh-VIE-tis) is a painful inflammation of the tendons on the thumb side of your wrist. If you have de Quervain's tenosynovitis, you're likely to feel discomfort every time you turn your wrist, grasp anything or make a fist. Although the cause of de Quervain's tenosynovitis isn't known, any activity that relies on repetitive hand or wrist movement — such as working in the garden, playing music, knitting, cooking, lifting your baby or walking your pet — can aggravate the condition. Treatment for de Quervain's tenosynovitis may range from immobilizing your wrist and taking medications to surgery in more serious cases. If you start treatment early on, your symptoms of de Quervain's tenosynovitis should generally improve within four to six weeks.

Signs and symptoms
Patients with De Quervain tenosynovitis note pain resulting from thumb and wrist motion, along with tenderness and thickening at the radial styloid. Crepitation or actual triggering is rarely noted.
Signs of De Quervain's tendinitis
Pain may be felt over the thumb side of the wrist. This is the main symptom. The pain may appear either gradually or suddenly. Pain is felt in the wrist and can travel up the forearm. The pain is usually worse when the hand and thumb are in use. This is especially true when forcefully grasping objects or twisting the wrist. Swelling may be seen over the thumb side of the wrist. This swelling may occur together with a fluid-filled cyst in this region. Pain and swelling may make it difficult to move the thumb and wrist.
A "catching" or "snapping" sensation may be felt when moving the thumb. Numbness may be experienced on the back of the thumb and index finger. This is caused as the nerve lying on top of the tendon sheath is irritated.
The main signs and symptoms of de Quervain's tenosynovitis are pain and swelling near the base of your thumb. The pain may appear suddenly or may increase over time. If the condition goes too long without treatment, the pain
may spread farther into your thumb, back into your forearm or both. Pinching, grasping and other movements of your thumb and wrist aggravate the pain
Symptoms of de Quervain's tenosynovitis include:
Pain near the base of your thumb
Swelling near the base of your thumb
A fluid-filled cyst in the same region as the swelling and pain
Difficulty moving your thumb and wrist when you're doing activities that involve grasping or pinching
A "sticking" or "stop-and-go" sensation in your thumb when trying to move it
A squeaking sound as the tendons try to move back and forth through the inflamed sheaths
Avoiding repetitive thumb movements whenever possible
Avoiding pinching with your thumb when moving your wrist from side to side
Applying cold to the affected are
Using nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin, others) and naproxen.
If the pain continues to interfere in your daily life or activities, seek medical advice.

Causes
When you grip, grasp, clench, pinch or wring anything in your hand, you use two major tendons in your wrist and lower thumb. These tendons run side by side from your forearm through the thumb side of your wrist. They normally glide unhampered through the small tunnel that connects them to the base of the thumb. In de Quervain's tenosynovitis, the tendons' slippery covering becomes inflamed, restricting movement of the tendons. Chronic overuse of your wrist is commonly associated with de Quervain's tenosynovitis. For example, wringing out a cloth involves a repetitive motion, a bent wrist and the gripping of the cloth. If you repeat an action like this day after day, this combination may be enough to irritate the sheath around the two tendons.
Tests and diagnosis
 llustration showing Finkelstein test

To diagnose de Quervain's tenosynovitis, your doctor likely will confirm that you have both:
Tenderness when pressure is applied on the thumb side of the wrist
Positive results on a Finkelstein test
In a Finkelstein test, you bend your thumb across the palm of your hand and bend your fingers down over your thumb. Then you bend your wrist toward your little finger. If this causes pain on the thumb side of your wrist, the test is considereImage.