A Tale of Two Tendons: de Quervain Syndrome

de Quervain syndrome, also called de Quervain tenosynovitis (DQT), is a problem in people who make a repetitive motion with their hand, wrist and thumb. The motion can be involved with pursuits ranging from trimming bushes to factory work to typing to tennis. Fritz de Quervain, a Swiss surgeon, is credited with identifying the syndrome in 1895.

In DQT, the fibrous sheath surrounding two tendons is inflamed. Both tendons—the extensor pollicis brevis (EPB) and abductor pollicis longus (APL)—are located on the inside edge of the wrist on the thumb side. The sheath is like a tunnel through which the tendons travel, and it is lined with a tissue called the tenosynovium. When that becomes inflamed from overuse, the movement of the tendons within is restricted and painful.

To relieve the pain, over-the-counter anti-inflammatory medication is usually a good start, with your physician’s approval, as is icing. If the pain still does not resolve, a cortisone injection will likely help. Just as important is what you do not do. Give the tendons a rest. Avoid the activity that caused the DQT—or at least avoid performing it in the same way—along with any others that would strain the area.

To help you rest the affected area, we will likely prescribe a device called a thumb-spica splint for your thumb and forearm. This will immobilize the wrist and lower thumb joints. While it can be cumbersome, the splint is necessary to promote proper healing. After the tenosynovium has sufficiently healed, we will develop a program of exercises tostrengthen your wrist and improve your range of motion.

To prevent a recurrence, we will evaluate the motions that caused the DQT in the first place. If you developed DQT at work, for instance, we will check your workstation and see how you typically sit and use your hands there (keyboarding, texting, etc.). Then we will make recommendations for healthier positions and movements.

The good news is that while DQT can be quite painful, it is fortunately a condition that can often be treated quite successfully. Performing the right exercises and making adjustments in your activities will likely get you back to full range of motion, free from pain.