De Quervain’s Tenosynovitis (DQT) is a common, painful condition affecting the tendons on the thumb side of the wrist. It involves the abductor pollicis longus (APL) and the extensor pollicis brevis (EPB), which move the thumb away from the hand. These tendons normally glide smoothly through a narrow, fibrous tunnel, or sheath, located near the wrist bone. DQT develops when the lining of this sheath, the synovium, becomes swollen and inflamed. This swelling constricts the space, preventing the tendons from gliding freely, causing friction, pain, and tenderness that often worsens with movement and can radiate up the forearm.
Understanding Resolution and Recurrence
De Quervain’s Tenosynovitis is highly treatable and typically resolves with appropriate intervention. It is considered a temporary condition that responds well to a structured management plan, though it rarely resolves completely if left untreated. The goal of treatment is to reduce inflammation and restore the smooth gliding of the affected tendons. When treatment is initiated early, symptom improvement can begin within four to six weeks, leading to full resolution over several months. Recurrence is possible, but uncommon, especially if the underlying repetitive activities that caused the condition are identified and modified.
Factors Contributing to Development
The primary cause of DQT is chronic overuse of the thumb and wrist, leading to repetitive friction and irritation of the tendon sheath. Activities involving forceful gripping combined with side-to-side wrist motion, or sustained pinching, are frequent contributors. This strain is common in occupations and hobbies such as manual labor, gardening, or racket sports. DQT is also associated with the care of infants, often called “mommy thumb,” due to the repetitive motion of lifting a baby. Hormonal changes during pregnancy and postpartum also increase risk, as fluid retention contributes to pressure within the tendon sheath, making women aged 30 to 50 more susceptible than men.
Conservative Treatment Options
The initial approach focuses on conservative, non-surgical methods aimed at reducing inflammation and resting the affected structures. This involves rest and activity modification, meaning avoiding the specific motions that aggravate the pain. Immobilization is achieved using a thumb spica splint, which supports both the wrist and the thumb. Wearing the splint restricts the movement of the APL and EPB tendons, providing rest to reduce mechanical impingement and allowing inflammation to subside.
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can help manage pain and reduce inflammation. A more targeted and effective treatment is a corticosteroid injection directly into the tendon compartment. The corticosteroid is a potent anti-inflammatory agent that reduces swelling in the tendon sheath, relieving pressure on the tendons. Injections are considered the most successful conservative treatment, with success rates ranging from 50% to over 90% after one or two injections, especially if administered early. Physical or occupational therapy often follows, focusing on gentle stretching and strengthening exercises to restore full range of motion and functional strength.
When Surgical Intervention Is Needed
Surgical intervention is reserved for cases where conservative treatments, including corticosteroid injections, fail to provide lasting relief. Unsuccessful non-operative methods suggest the fibrous tunnel is structurally too tight for the inflamed tendons to move freely. The procedure is a surgical release of the first dorsal compartment, where the surgeon makes a small incision and cuts the roof of the compartment (the extensor retinaculum). This action opens the restricted tunnel, immediately releasing pressure on the APL and EPB tendons and allowing them to glide without friction. The outcome is generally excellent, providing lasting pain relief and functional improvement, followed by several weeks of limited activity to regain full strength.