De Quervain’s disease is a common cause of pain on the thumb side of the wrist. It can make everyday activities such as lifting, gripping, wringing out a cloth or opening jars painful and difficult.
Mr Robert Farnell is an experienced specialist Consultant Orthopaedic Hand and Wrist Surgeon who has been working in Leeds for over 25 years. He exclusively treats conditions affecting the adult hand and wrist, including carpal tunnel syndrome, trigger finger and thumb, thumb arthritis and Dupuytren’s disease.
What is De Quervain’s disease?
De Quervain’s disease is a condition which causes pain at the thumb side of the wrist. It is also known as De Quervain’s stenosing tenovaginitis and was first described by a Swiss surgeon in 1895.
The condition affects two tendons which pass through a narrow tunnel at the wrist. When the tendon sheath becomes thickened and narrowed, the tendons can become irritated or catch as they move.
Anatomy of De Quervain’s disease
Many tendons pass over the back of the wrist joint. These tendons extend the thumb, fingers and wrist. They run in separate compartments, or tunnels, which are formed by the radius bone and a fibrous sheet of tissue called the extensor retinaculum.
These tunnels are lined with synovium, which lubricates the tendons and enables them to run smoothly. The first extensor compartment is located over the base of the thumb and is the compartment involved in De Quervain’s disease.
Two tendons run through this tunnel: abductor pollicis longus and extensor pollicis brevis.
Figure 1: Position of the first extensor compartment.
What causes De Quervain’s disease?
Although some people refer to the condition as tenosynovitis, it is not believed to be an inflammatory condition. It is thought to be due to degenerative changes in the tendon and surrounding tendon sheath.
It is therefore more correctly called stenosing tenovaginitis or De Quervain’s disease. The end result is thickening and narrowing of the tendon sheath, which causes the tendons to catch as they move.
De Quervain’s disease is more common in people between 30 and 50 years old and women are affected more commonly than men. In most cases, there is no history of trauma.
Symptoms of De Quervain’s disease
Pain and tenderness over the thumb side of the wrist are typical. Symptoms usually develop gradually, although in some people they can occur quickly.
Pain is often worse with thumb movement and with activities requiring thumb pinch grip.
Symptoms may include:
- Pain on the thumb side of the wrist
- Tenderness over the base of the thumb and wrist
- Pain when lifting or gripping objects
- Pain when wringing out a cloth
- Pain when opening jars
- Pain when moving the thumb
How is De Quervain’s disease diagnosed?
Diagnosis is usually based on your symptoms and clinical examination. Your surgeon will assess the location of the pain, tenderness over the first extensor compartment and whether thumb or wrist movement reproduces symptoms.
A common clinical test is Finkelstein’s test. This may cause severe pain if the thumb is clasped into the palm of the hand and the wrist is then moved towards the little finger.
Find out what to expect at your outpatient appointment.
Treatment for De Quervain’s disease
Treatment depends on the severity of symptoms, how long they have been present and whether non-surgical treatment has already been tried.
Non-surgical treatment
Many people respond well to non-surgical treatment. This may include:
- Pain relief medication
- Anti-inflammatory medication, if tolerated
- Use of a splint to rest the wrist and thumb
- Physiotherapy
- Steroid injection into the first extensor compartment
A splint can help rest the wrist and thumb. A steroid injection may reduce symptoms, although the amount and duration of improvement can vary between patients.
Surgical treatment
Surgery may be considered when symptoms remain troublesome after non-surgical treatment.
The operation is called De Quervain’s release. Surgery releases the roof of the first extensor compartment to free the tendons and allow them to glide more easily.
This surgery is performed as a day case procedure using local anaesthesia. After surgery, many surgeons leave a bulky bandage in place for up to two weeks before it is removed and mobilisation is permitted.
In most cases, surgery resolves the pain and discomfort.
Possible complications of surgery
Surgical complications are uncommon. Possible complications include:
- Wound infection, which occurs in approximately 1% of cases
- Temporary scar tenderness
- Numbness or sensitivity over the scar and back of the thumb
Read more about post-operative care.
Concerned about thumb-side wrist pain?
If pain on the thumb side of your wrist is affecting grip, lifting or day-to-day activities, Mr Robert Farnell can assess your symptoms and advise whether splinting, injection treatment or surgery may be appropriate.
De Quervain’s disease FAQs
These answers are provided to help patients understand the key points about De Quervain’s disease, symptoms, diagnosis and treatment options.
What is De Quervain’s disease?
De Quervain’s disease is a condition which causes pain on the thumb side of the wrist. It affects the tendons passing through the first extensor compartment at the wrist.
What does De Quervain’s disease feel like?
De Quervain’s disease usually causes pain and tenderness at the thumb side of the wrist. Pain is often worse with thumb movement, gripping, lifting, wringing out a cloth or opening jars.
What causes De Quervain’s disease?
De Quervain’s disease is thought to be due to degenerative changes in the tendon and surrounding tendon sheath. This causes thickening and narrowing of the tendon sheath.
Who gets De Quervain’s disease?
De Quervain’s disease is more common in people between 30 and 50 years old and women are affected more commonly than men.
How is De Quervain’s disease diagnosed?
De Quervain’s disease is usually diagnosed clinically from symptoms and examination findings. Finkelstein’s test may reproduce pain at the thumb side of the wrist.
Can De Quervain’s disease be treated without surgery?
Yes. Many people improve with non-surgical treatment such as pain relief medication, anti-inflammatory medication, splinting, physiotherapy or a steroid injection into the first extensor compartment.
When is surgery considered for De Quervain’s disease?
Surgery may be considered when symptoms remain troublesome despite non-surgical treatment.
What is De Quervain’s release?
De Quervain’s release is an operation which releases the roof of the first extensor compartment to free the tendons and allow them to glide more easily.
Is De Quervain’s release successful?
In most cases, surgery resolves the pain and discomfort associated with De Quervain’s disease.
What are the possible complications of De Quervain’s release?
Complications are uncommon but may include wound infection, temporary scar tenderness, numbness or sensitivity over the scar and back of the thumb.