De Quervain’s Tenosynovitis: Causes, Symptoms, Prevention, Treatment, Ayurveda Understanding

Article by Dr Manasa S, B.A.M.S

De Quervain’s tenosynovitis is a painful condition characterized by swelling in the tendons around the thumb, specifically impacting the abductor pollicis longus and extensor pollicis brevis muscles. Named after Swiss surgeon Fritz de Quervain, this condition occurs when the tendons become constricted within their protective sheath, often due to repetitive thumb or wrist movements. While most individuals find relief through conservative treatment, in some cases, surgical intervention may be required to restore function and alleviate discomfort.

A painful condition like De Quervain’s Tenosynovitis draws our attention towards Vata being the main culprit in the causation of the disease. Since the Vata impacts the muscles and tendons around the thumb, it can be considered as mamsagata vata or Snayu / kandaragata vata in the region of the thumb and wrist. Vatarakta – a condition compared to gout, will also present with pain in the thumb and hand, though it is more complex. Amavata – which has been correlated with Rheumatoid Arthritis and Sandhigata Vata – which has been correlated with osteoarthritis can also be considered in this context, as occurring in the region of and limited to the thumb and hand.

Causes of de Quervain’s Tenosynovitis

–        Thickening and degeneration of the protective tendon sheath around the thumb tendons, leading to tendon entrapment, pain, and swelling.

–        Repetitive thumb or wrist movements, particularly radial abduction (moving the thumb away from the index finger).

–        Less commonly, a sudden traumatic injury to the wrist or thumb area.

Even in this context, we can see that most causes point towards involvement of vata in the pathogenesis. Constriction of tendon sheath as well as degeneration are also affected by Vata aggravation. Entrapments are due to Vata. The other important cause of this disorder is repetitive movements – which is yet another cause of vata aggravation and so is trauma. Excessive movements and trauma collectively cause Vatarakta, which also presents with joint related symptoms involving hands and feet, in spite of being a systemic disorder.

Activities that Increase Risk

–        Gardening

–        Lifting young children

–        Using hand tools, such as a hammer

–        Repeatedly administering injections, leading to “injector’s thumb”

Sports involving repetitive wrist gripping and bending, including:

–        Tennis

–        Badminton

–        Golf

–        Racquetball

From the Ayurveda perspective, all these fall under ‘ati vyayama’ i.e. excessive activities, which cause aggravation of vata.

Symptoms of De Quervain’s Tenosynovitis

Individuals with de Quervain’s tenosynovitis may experience:

–        Pain along the back of the thumb, particularly over the affected tendons

–        Swelling and pain at the base of the thumb

–        Swelling and tenderness on the thumb side of the wrist

–        Difficulty moving the thumb, often described as a “sticking” or catching sensation

–        Numbness in the thumb or wrist

–        A popping or snapping sensation within the wrist

–        Formation of a fluid-filled cyst on the thumb side of the wrist

Pain and tenderness are obviously due to Vata, it might also occur due to simultaneous aggravation of vata and rakta, as in vatarakta. Swelling is due to kapha if it is non-inflammatory and due to pitta or rakta or aa if it is inflammatory. Swelling with degeneration is due to vata. Difficulty in movements, numbness and popping sensation, all are due to Vata.

Symptoms may develop gradually or start abruptly, with pain potentially radiating from the wrist into the thumb or up the forearm. Movement of the thumb—especially pinching or grasping—often exacerbates the pain, which can worsen with increased thumb or wrist activity.

Risk Factors for De Quervain’s Tenosynovitis

Frequent or repetitive use of the thumbs and wrists increases the risk of developing de Quervain’s tenosynovitis. Key activities and factors that raise the risk include:

–        Parenting and childcare: Frequent lifting and handling of young children

–        Sports: Activities that involve repetitive wrist and thumb movements, such as skiing, golf, rowing, and racket sports like tennis

–        Manual labor: Jobs involving repetitive wrist motions, such as hammering

–        Hobbies: Knitting, gardening, and gaming can place strain on the wrist and thumb

–        Device usage: Prolonged use of smartphones or tablets

Who Is at Risk?

De Quervain’s tenosynovitis can affect anyone, with approximately 1% of people in the U.S. experiencing it each year. However, certain factors increase the likelihood:

–        Age: Most common in adults aged 30–50

–        Gender: Women and those assigned female at birth are 8 to 10 times more likely to develop it

–        Pregnancy and Postpartum Period: Hormonal changes during pregnancy and repetitive lifting of a baby after birth can increase susceptibility

Potential Complications of Untreated de Quervain Tenosynovitis

Without appropriate treatment, de Quervain tenosynovitis can lead to progressively worsening pain and functional limitations in the affected hand and wrist. This can hinder day-to-day activities and make sports or other repetitive motions difficult to perform comfortably.

Surgical Intervention

In cases where conservative treatments prove insufficient, a small percentage of individuals may require surgery to alleviate symptoms. Though rare, surgical procedures carry potential risks, including:

–        Radial Nerve Injury: Damage to the radial nerve may result in altered sensation or motor function in the thumb and wrist.

–        Tendon Subluxation: The tendons may shift from their normal position, leading to further complications and movement restrictions.

–        Tendon Entrapment: Entrapment of the abductor pollicis longus and extensor pollicis brevis tendons can cause persistent pain and limit thumb mobility.

When to Seek Medical Attention

De Quervain’s tenosynovitis often improves with conservative care. However, it’s advisable to consult a healthcare professional if you experience:

–        Increasing pain

–        Pain that interferes with daily tasks

–        Emotional distress from persistent symptoms

–        Difficulty engaging in sports or repetitive wrist activities

Early intervention can help alleviate symptoms and prevent the need for more invasive treatments.

Diagnosing de Quervain’s Tenosynovitis

Physicians diagnose de Quervain’s tenosynovitis by performing a combination of clinical evaluations and imaging studies, including:

Physical Examination – The doctor will carefully examine the affected wrist and thumb, looking for tenderness, swelling, or pain along the tendons.

 Symptom Assessment – Patient symptoms, such as pain when moving the thumb or wrist, are reviewed for consistency with de Quervain’s tenosynovitis.

Medical History Review – A thorough review of personal and family medical history helps to identify any potential contributing factors.

Imaging Studies – X-rays may be ordered to rule out osteoarthritis or other bone abnormalities, although these are generally not required to confirm de Quervain’s diagnosis.

Specialized Physical Tests

The Eichhoff and Finkelstein tests are specific physical maneuvers that aid in diagnosing de Quervain tenosynovitis.

Eichhoff Test:

–        The patient is asked to place the thumb against the palm.

–        They are instructed to make a fist, with fingers wrapped around the thumb.

–        The wrist is then bent downward toward the little finger.

Finkelstein Test:

–        The patient places their forearm on a table, with their hand and wrist extended off the edge.

–        The examiner gently holds the thumb and flexes it toward the palm.

Interpretation of Results

If pain is elicited during either of these tests, it may indicate de Quervain’s tenosynovitis. However, these tests can yield false positives, as other wrist conditions may cause similar discomfort. The Finkelstein test is often considered more specific and accurate, though both tests are valuable diagnostic tools.

Treatment Options for De Quervain’s Tenosynovitis

The primary goals of treating de Quervain’s tenosynovitis are to alleviate pain, reduce inflammation, and prevent recurrence. Treatment approaches include:

Medications 

–        Initial treatment often involves over-the-counter anti-inflammatory medications, such as ibuprofen or naproxen, to reduce swelling and ease pain. 

–        If these are insufficient, your doctor may administer a steroid injection directly into the tendon sheath. Receiving this injection within six months of symptom onset can lead to complete recovery for many patients without additional treatments.

Splinting and Physical Therapy

–        A doctor-prescribed splint will immobilize your thumb and wrist, typically worn 24 hours a day for 4–6 weeks.

–        Physical therapy complements the splinting by introducing exercises to build strength and stability in your wrist, hand, and arm.

–        Surgery

–        If conservative treatments don’t provide relief, outpatient surgery may be recommended. The procedure releases the tendon sheath to enable smooth tendon movement.

–        Post-surgery, you’ll work with a physical therapist on targeted exercises to restore strength and flexibility to your thumb and wrist.

Home Remedies and Lifestyle Adjustments

–        Apply ice packs to the affected area to relieve inflammation. 

–        Avoid activities that aggravate symptoms, especially repetitive thumb movements and pinching. 

–        Continue wearing your splint as directed and maintain prescribed exercises for optimal recovery.

Expected Recovery Timeline

–        Conservative Treatment: With early intervention, many people experience relief within 4 to 6 weeks. 

–        Pregnancy-related Cases: Symptoms often resolve after childbirth or upon the completion of breastfeeding. 

–        Post-Surgical Recovery: While pain and swelling should decrease soon after surgery, tenderness may persist for several months. Stitches are removed within 10–14 days, and physical therapy generally continues for 6–8 weeks, focusing on stretches and strengthening to improve tendon movement and joint stability. 

Early treatment leads to quicker and more effective recovery, so seek medical advice promptly if you suspect de Quervain’s tenosynovitis.

From Ayurveda perspective, treatment will be management of the underlying cause, avoiding the causative factors and treating Vata. Abhyanga, Dhara, Lepa, Upanaha, Virechana and Vasti will be the most important treatments to manage De Quervain’s Tenosynovitis.

Preventing De Quervain’s Tenosynovitis

Reducing overuse of your thumb and wrist is key to preventing de Quervain’s tenosynovitis. Additional preventive strategies include:

–        Wear Proper Gear: Use protective equipment and ensure correct technique for sports, hobbies, and work activities.

–        Pace Yourself: Gradually build up intensity when beginning new activities.

–        Take Regular Breaks: Incorporate breaks into repetitive activities to reduce strain on your wrist and thumb.

–        Listen to Your Body: Stop and rest if you experience wrist or thumb pain.

–        Allow Time for Recovery: After intense activity, give your wrist and thumb adequate rest.

–        Warm-Up Techniques: Use a heating pad to warm up your wrist before activity, and gently massage your wrist and thumb to enhance flexibility.

Exercises to Strengthen and Increase Flexibility

Strengthening with a Tennis Ball:

1.   Hold a tennis ball in the affected hand.
2.   Squeeze gently, gradually increasing pressure as long as there is no pain.
3.   Hold the squeeze for 5 seconds, then release.
4.   Perform 5-10 repetitions, a few times daily.

Thumb Lift Exercise:

1.   Place your hand on a flat surface, with the ulnar side down and thumb across your palm.
2.   Slowly raise your thumb straight up.
3.   Hold for 6 seconds.
4.   Perform 8-12 repetitions.

Engaging in these exercises regularly can help strengthen the thumb and wrist, improving resilience and reducing the risk of de Quervain’s tenosynovitis.

Related Research works and Studies

Study related to epidemiology of De Quervain’s Tenosynovitis –

–        One study estimated the prevalence of the disease to be 0.5% in men and 1.3% in women, with peak prevalence among those in their forties and fifties.

–        Another study determined the prevalence to be 0.36 % in women and 0.13% in men.

–        The condition was seen more commonly in those with a history of medial or lateral epicondylitis.

–        Bilateral involvement was reported in new mothers or child care providers in whom spontaneous resolution typically occurs once lifting of the child is less frequent.

–        Pregnancy and manual labour are two significant risk factors for the disease.

Study – Carpal Tunnel Syndrome was significantly associated with De Quervain’s Tenosynovitis

Related Reading – ‘Ayurveda Understanding of De Quervain’s Tenosynovitis’