If you have pain here in the base of the thumb when you cover your thumb with the other fingers
and pull the wrist down, this likely De Quervain tenosynovitis.
Today I'll explain how to prevent and treat this condition.
Let's talk about De Quervain Tenosynovitis today
Before I continue, let me remind you that this video is not intended to replace medical advice.
It is for educational purposes only. If you need medical advice, contact your doctor.
In case of emergency, go to the nearest emergency department or call 911.
This disease is named after Dr. Fritz de Quervain, a Swiss surgeon who died in 1940.
He was the first person to describe the symptoms and the cause of this tenosynovitis.
This is an inflammation that involves two tendons, the abductor pollicis longus and the extensor
pollicis brevis. These muscles are involved in activities like repetitive hammering,
lifting or pipetting. The tendons are protected by a synovial lining, and when there are repetitive
movements, there will be some inflammation. This condition is usually seen in new mothers or
nursing mothers, most likely due to the new use of their hands holding their heavy babies.
Inflammation means swelling, pain, hot and red. There is no x-ray or imaging test that needs to be
ordered to diagnose this condition. The diagnosis is made by doing this maneuver with the wrist
and hand, called the Finkelstein test. If the patient reports pain at the base of the thumb,
then the test is positive and the patient has De Quervain tenosynovitis.
The treatment involves activity modification. I recommend the person avoid lifting objects
with the palms down. They need to remember to turn the palms up before lifting objects.
Also, avoid activities that they have to pinch with their thumbs, like pipetting. If they can't
avoid these activities, then we can modify their tools, like using a large handle to grab objects.
The goal of treatment is to reduce inflammation. I recommend the patient buy a thumb spica
splint and wear it at night to immobilize the thumb, at least when the person is sleeping.
If possible, also wear the splint during the day. These are some types of splints that patients buy.
I will leave some links in the description of this video below if you want to purchase
a thumb splint. But you should be able to find them easily in your local pharmacies.
Patients can also apply a topical cream of anti-inflammatory like diclofenac.
They have to apply it at least 3 times a day. Some patients do not like to apply
creams on their hands during the day. In this case, they can take anti-inflammatory pills.
I have another video that I talk about the various types of NSAIDs,
their doses and contra-indications. Applying local ice can help to reduce
the pain and inflammation, but ice has to be applied for at least 15 minutes.
When these conservative measures do not resolve the symptoms, I do steroid injections around the
tendons, and this will reduce the inflammation. If the symptoms persist after the injection,
I refer the patient to a hand surgeon, that could be an orthopedic or plastic surgeon.
In that case, the surgeon may need to perform surgical decompression around the tendons.
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Thank you for watching. Goodbye!