deQuervain's tenosynovitis is a condition that results in pain and swelling of the lining around the tendon(s) that extend to the thumb. Inflammation occurs because of friction between the tendon(s) and the outer lining, or friction over the bones of the wrist.

SYMPTOMS:

• Pain and swelling in the thumb/wrist that is aggravated with movement. Pain may travel up the forearm.
• Limited movement of the thumb/wrist
• Weakness and loss of strength in thumb/wrist
• A grating, crunching, or popping sensation that occurs when thumb/wrist is moved
  

  WHAT CAUSES THIS CONDITION?

• Overuse of the thumb/wrist (repetitive or excessive use)
• Activities involving gripping or pinching with the thumb
• Direct trauma to bones of the wrist
• Metabolic conditions which do not cause deQuervain's but can be associated: diabetes, hyperthyroidism, hyperuricemia, rheumatoid arthritis, or pregnancy
• 3 to 10 times more common in women than men, because women's wrists tend to angulate more than men's

  TREATMENT

  The goal of treatment is to reduce inflammation by:

• Stopping activities that aggravate symptoms
• Resting and immobilizing thumb/wrist in a splint (worn at all times for total rest 1-4 weeks, then splint is gradually weaned over the next weeks as able). It is advisable to protect your thumb when out of splint (eg. when bathing) by resting it beside your index finger!
• Controlling pain and swelling by icing (use ice in plastic bag, or package of frozen vegetables)
  • Instructions: Put damp cloth over thumb and wrist area, place bag over thumb/wrist, leave for 15 minutes, and then remove ice. Do this at least 3 times per day.
• Exercise program to help maintain movement and strength in thumb and wrist (begun after 1-4 week period of total rest is over). Heavy hand activity or repetition is not advisable until 4-8 weeks. See exercise sheet.
• Some medical treatments could include:
  1. anti-inflammatory medications
  2. injection of steroids into wrist (if symptoms persist)
  3. surgery (if symptoms persist and are severe)

  
  THUMB PROTECTION TECHNIQUES: Try to avoid doing activities that are going to aggravate symptoms.

• Prolonged pinching
• Forceful thumb movements
• Repetitive thumb movements
• Combined pinching/gripping with repetitive wrist movements

  REVIEW OF JOB DEMANDS: Can any adaptions be made to the workplace, or home environment?

• Change in location and position of equipment
• Shortened work day and activities
• Rotating work stations and activities (heavy to light)
• Modify work habits
• Splint for support while working
• More frequent rest breaks
• Energy conservation techniques

  REMEMBER: There is always a potential for symptoms to reappear! Caution is required when performing repetitive activities that involve thumb/wrist action, even after you have healed or have less pain.