What is DeQuervain’s Syndrome? How can you treat and prevent future discomfort in your wrists?

De Quervain’s syndrome (aka Radial styloid tenosynovitis, washerwoman’s sprain or mother’s wrist) is the inflammation  of the covering of two tendons of the thumb. This inflammation causes compression of the tendons, reducing their ability to slide through during movement.

This condition is not commonly associated with any disease process nor is it a dangerous condition. It does, however, often require intervention to improve. This syndrome is more common in women than in men. Quervain’s syndrome is similar to tennis elbow and carpal tunnel syndrome as a condition brought on by overuse and repetitive movements.

Anatomy Involved

The thumb and wrist are used in many actions during the course of a day. Gripping, holding, lifting, turning handles, driving a car and many other daily manoeuvres require the thumb and the wrist.

The joints are held together by strong ligaments and tendons. These are attached to the muscles that contract and relax to allow movement. The tendons and ligaments can be injured by acute forces outside the normal joint range. They can also be injured or become inflamed, from over or repititive use.

Quervain’s syndrome is one of those injuries to the thumb and wrist that can be very painful and,in extreme cases, debilitating.

The Non-Jargon Technical Bit!

This condition involves two of the tendons that control movement in the thumb. The tendons are attached to muscles on the back of the forearm. They travel side by side on the inside of the wrist. At the wrist they travel through an opening at the end of the radius bone, which serves as a guide. The lining of the opening, provides a slippery surface for the tendons to glide over as they move the thumb.

In the case of Quervain’s tenosynovitis, the inflammation causes an impingement of the tendons in the tunnel, causing friction and further inflaming the area and structures.

What causes Quervain’s Syndrome?

Quervain’s syndrome is an overuse injury like many other tendon injuries. Continuous gripping, pinching, squeezing or wringing motions can lead to this condition, hence the name washerwoman’s sprain. New mums frequently develop the condition from cradling their baby in the same arm for extended periods.

Injury to the wrist or thumb may lead to the development of scar tissue in this area, and as the scar tissue develops the tendons become impinged. Arthritis is an inflammation, commonly found in joints, and so therefore this inflammation exacerbates the condition.

Signs and Symptoms

Pain in the thumb and lateral wrist, over the radius, especially during use, is common with this injury. Tenderness and swelling over the area may also be present. The pain may progress further up the forearm as the injury worsens. A  progressive loss of function in the thumb may occur due to the increasing pain. The range of motion of the thumb may begin to decrease. ‘Creaking’ may be experienced in the affected area.

Treatment

• Rest, ice and NSAIDs may provide relief and reversal of this condition,especially if it is caught early enough. Splinting with a thumb-spica splint may be necessary to reduce the movement of the wrist and lower joints of the  thumb.
• If these interventions do not work, then your GP may advise a steroid injection into the irritated area.
• Sports injury management is beneficial to retrain movements to avoid future episodes.
• If everything else fails surgery  may be required to release the tendons and provide more space for them to move.

Prevention

Prevention of overuse injuries commonly requires breaking up sessions of work or practice involving a particular area into shorter periods with more frequent breaks to allow that area to rest and avoid the overuse.

• A proper warm up before doing any lifting, grasping or holding for extended periods may prepare.
  the tendons for the task and prevent some of the strain placed on them.
• Avoidance of activities that cause pain is a common sense prevention method that often gets ignored. If  a movement causes pain, find another activity or action that accomplishes the same task without the pain.
• Flexible muscles reduce overall tension on the tendons, which reduces the inflammation to the sheaths that cover them.