Standing beside the ocean, looking across the water
Everything is beautiful here but I still don’t feel like I oughta
from the song “Dancing the Night Away” by the Amazing Rhythm Aces
One of the most common conditions that involves inflammation, or swelling, in the hand and wrist is called “Dequervain’s Tendonitis”. The names comes from a Swiss physician who first described the problem way back in 1895. People pronounce this in various ways, most commonly something like De-kwer-vains. The problem involves a group of tendons that help to move the thumb. The tendons get irritated as they pass through a sheath that helps hold them close to the bone. Most patients have pain with movement of their thumbs and swelling in their wrists on the side of the wrist near the thumb. Most of the time the swollen area if very tender. Some patients will get popping of their thumbs when they move their thumb because the tendons are so swollen they are popping as they pass in and out of their sheath.
As far as anatomy goes, there are 6 groups of tendons that pass through compartments in the wrist. The tendons involved in Dequervain’s are in the first compartment so Dequervain’s is also known as first dorsal compartment tendonitis. There are two tendons involved with the elegant names of the abductor pollicis longus and the extensor pollicis brevis. The help move the thumb away from the other fingers and lift the thumb away from the palm. Most people have one compartment for both tendons, but people who have Dequervain’s can have two seperate compartments, one for each tendon.
Most of the time there is no known cause and the symptoms seem to appear out of nowhere. Some patients recall a minor injury, while others relate the problem to increased use and repetitive activity of the thumb and wrist. In all likelihood the tendons get inflamed through some change in activity and then the repetitive use probably doesn’t allow the tendon to heal and rest. In patients with two separate compartments, as mentioned above, I think the tendons just don’t have enough room to heal when they get irritated and inflamed.
It’s usually not too hard to diagnose the problem. Patients usually have pain with movement of both the thumb and wrist, and most of the time there are very specific activities that aggravate the problem. Swelling and tenderness over the first dorsal compartment is usually seen as well. There is a specific test to help diagnose the problem which is known as Finklestein’s test. The best way to describe how to do this test would be to bend you thumb into the palm, grab the thumb with your fingers, then make a motion like you are casting a fishing pole. If you have Dequervain’s that test should reproduce the pain and discomfort that you are having.
Initial treatment usually consists of rest, ice, over the counter non-steroidals like Aleve or Advil and avoiding as much as possible the activities that aggravate the problem. If these don’t work a brace that immobilized the thumb is a good idea. I see a lot of patients who have braces the hold the wrist still but don’t do anything to the thumb and rarely do these help at all. The thumb has to be pretty still for the brace to work, and the splints often are called thumb spica splints.
If these initial treatments don’t work and the symptoms persist and cause problems, then the next most reasonable options are cortisone injections or surgery. I haven’t tried creams or rubs very much because most patients don’t seem to be helped by them, but it’s an option if the patient wants to avoid something invasive.
Cortisone shots work fairly well for Dequervain’s. Probably 70% or more of the patients who receive an injection will get relief of their symptoms, often without any further problems. If the shot works initially and then the symptoms recur then another injection is a reasonable way to go. If the shots fail to work or quit working then surgery is an option. The surgery involves opening up the sheath where the tendons are inflamed and cleaning out the inflamed tissue. The surgery can be done as an outpatient under local anesthesia with or without sedation and is usually successful with few complications.
Dequervain’s tendonitis is a common condition that can be successfully treated without surgery, but surgery is an option if other treatments don’t work.