De Quervain's Disease

What happens in De Quervain's disease

Two tendons, the abductor pollicis longus and extensor pollicis brevis, move the thumb out and back. At the wrist they run together through a tight tunnel (the first dorsal compartment) over a bony bump on the radius bone, the radial styloid.

Repeated thumb and wrist movements, especially combined with gripping and sideways wrist bending, cause the tendons and their sheath to thicken. The tunnel becomes crowded, so the tendons no longer glide smoothly. Under the microscope, the problem is mainly thickening and degeneration rather than inflammation, which is why some specialists call it De Quervain's tendinosis.

Causes and risk factors

• New parenthood: repeatedly lifting a baby with the thumbs outstretched, which is why it is nicknamed "mommy thumb" or "baby wrist". It affects fathers and other caregivers too
• Pregnancy and breastfeeding: fluid retention and hormonal changes
• Repetitive activities: texting, gaming, typing, gardening, racquet sports, golf, carpentry and assembly-line work
• Female sex and age 30 to 50
• Rheumatoid arthritis and diabetes
• Direct injury to the wrist

Symptoms

• pain over the thumb side of the wrist, sometimes spreading up the forearm or into the thumb
• pain with gripping, pinching, wringing, lifting, or turning a key or doorknob
• swelling over the base of the thumb, sometimes a small fluid-filled bump
• a catching, snapping or creaking feeling when moving the thumb
• weak grip
• numbness over the back of the thumb if a nearby nerve is irritated

Finkelstein test

A simple test confirms the diagnosis in most cases:

1. Make a fist with your thumb tucked inside your fingers.
2. Gently bend your wrist down toward your little finger.

Sharp pain over the thumb side of the wrist suggests De Quervain's disease. A related version, the Eichhoff test, is the same movement done by the examiner.

Conditions that can look similar

Diagnosis

Diagnosis is usually made from the history and examination. X-rays may be taken to rule out arthritis or a fracture. Ultrasound can show thickened tendons and a dividing wall (septum) inside the tunnel, which can affect injection success.

Treatment

Rest and splinting

• Thumb spica splint: holds the thumb and wrist still, usually worn for 4 to 6 weeks, day and night at first
• Activity changes: avoid pinching, wringing and sideways wrist bending. Lift your baby by scooping with palms up and forearms underneath, rather than with thumbs outstretched
• Ice for 10 to 15 minutes several times a day
• Pain relief: ibuprofen or naproxen at the label dose, or topical NSAID gel, avoiding oral NSAIDs if you have kidney problems, stomach ulcers or take blood thinners

Steroid injection

A corticosteroid injection into the tendon sheath is the most effective non-surgical treatment, relieving symptoms in most people, often with one injection. Ultrasound guidance can improve accuracy. Side effects can include skin thinning or lightening at the injection site. Injections are generally considered safe while breastfeeding, but discuss this with your doctor.

Physical or hand therapy

Once pain settles, gentle stretching and strengthening help you return to normal use. Therapists can also advise on ergonomics and parenting techniques.

Surgery

For persistent symptoms after injections and splinting, usually after 4 to 6 months, a short outpatient operation under local anesthetic opens the roof of the tunnel to give the tendons more room. Most people regain full function within a few weeks to a couple of months. Risks include irritation of the nearby sensory nerve and, rarely, tendon slipping.

Outlook

Most people recover within 4 to 6 weeks of starting treatment. Pregnancy-related and postpartum cases often settle once breastfeeding ends and the baby needs less lifting. Recurrence is possible if the same strain continues.

Frequently asked questions

What causes De Quervain's disease?

It is caused by repeated thumb and wrist movements that thicken the tendons and their tunnel at the thumb side of the wrist. Lifting a baby, texting, gardening and racquet sports are common triggers. Pregnancy, the postpartum period and rheumatoid arthritis also increase the risk.

How is De Quervain's disease diagnosed?

A doctor diagnoses it by examining the wrist and performing the Finkelstein test: making a fist with the thumb tucked in and bending the wrist toward the little finger. Pain over the thumb side of the wrist points to De Quervain's. X-rays help rule out arthritis or a fracture.

How long does De Quervain's take to heal?

With splinting, activity changes and often a steroid injection, most cases improve within 4 to 6 weeks. Cases linked to pregnancy and new parenthood may persist until breastfeeding stops. Surgery is considered if symptoms last 4 to 6 months despite treatment.

What is "mommy thumb"?

It is a common name for De Quervain's disease in new parents, caused by repeatedly lifting and holding a baby with the thumbs spread. Changing lifting technique, using a thumb splint and sometimes a steroid injection usually resolve it.

Is De Quervain's the same as carpal tunnel syndrome?

No. De Quervain's affects tendons on the thumb side of the wrist and causes pain with thumb and wrist movement. Carpal tunnel syndrome is a pinched nerve on the palm side of the wrist that causes numbness and tingling in the thumb, index and middle fingers.