De
Quervain's (say "duh-kair-VAZ") disease is a problem that makes the bottom of
your thumb and the side of your wrist hurt. When you have
de Quervain's disease, the ropelike fiber (tendon) that helps move your thumb away from your
fingers becomes swollen. See a picture of
de Quervain's disease.
What causes de Quervain's disease?
People can get de Quervain's disease when they
hurt or use the thumb or wrist too much. Common activities that need your wrist
and thumb can cause the problem. Some activities that might cause de Quervain's
disease are:
Wringing out wet
clothes.
Hammering.
Skiing.
Knitting.
Lifting
heavy objects such as a jug of milk, taking a frying pan off of the stove, or
lifting a baby out of a crib.
If you are pregnant or if you have
diabetes or
rheumatoid arthritis, you are more likely to get de
Quervain's disease. More women than men have de Quervain's disease. You can get
the disease at any age. Most people who have de Quervain's disease are women
between the ages of 30 and 50.
What are the symptoms?
De Quervain's disease may cause pain when you
twist your wrist. You might also have pain if you grab something between your
thumb and finger. Many people hear a funny sound like a squeak, crackle, snap,
or creak when they move the wrist or thumb.
The bottom of the
thumb or the side of the wrist might also be sore or swollen. This can make it
hard to move your thumb or wrist. The back of the thumb and index finger may
also feel numb. Sometimes de Quervain's disease can cause a
cyst on the thumb side of the wrist. If you don't get
treatment, the pain can spread up your forearm or down into your thumb.
How is de Quervain's disease diagnosed?
Your
doctor may or may not use the Finkelstein test to help diagnose de Quervain's
disease. To do this test make a fist with your thumb inside. Then bend your
wrist outward toward your little finger. If you feel pain on the thumb side of
your wrist, then you most likely have de Quervain's disease.
The
Finkelstein test is done to make sure that you do not have a different problem,
such as arthritis in the bottom of your thumb or
intersection syndrome. Both of these problems affect
the same area of the hand and wrist as de Quervain's disease.
How is it treated?
The goal of treatment for
de Quervain's disease is to relieve the pain and swelling in your thumb and
wrist, and restore normal function. Try the following steps to help your
symptoms:
Avoid moving the hand and wrist that hurt.
Stop
the activities that caused the pain until your symptoms are
better.
Keep your wrist in a straight line with your arm by using a
splint to keep your thumb and wrist from moving.
Try ice or heat on the area that hurts or is swollen. You can use ice
for 15 minutes every 4 to 6 hours. Put a thin cloth between the ice and your
skin. You can use heat for 20 to 30 minutes, 2 or 3 times a day. Try using a
heating pad, hot shower, or hot pack.
Use
nonsteroidal anti-inflammatory drugs (NSAIDs),
including aspirin (such as Bayer), ibuprofen (such as Advil), or naproxen
sodium (such as Aleve). Do not give aspirin to anyone younger than 20 because of the risk of
Reye syndrome.
Your symptoms will usually start to get better in 3 to 4
days. But if your wrist or thumb still hurts, your doctor might give you a
corticosteroid shot, also called a steroid shot. A
medicine called steroid is injected into your wrist area and the bottom of your
thumb.
Within 3 weeks of having a steroid shot, most people can
use the wrist and thumb again for normal activities. Research shows that up to
83% of people who have de Quervain's disease feel less pain or feel completely
better after a steroid shot.1, 2 Most people feel better after just one shot, but you might
need another shot after 4 to 6 weeks if your wrist and thumb still hurt. No
more than 3 shots are used.
If your wrist and thumb do not feel
better after trying home treatment and getting 3 shots, your doctor might talk
to you about surgery. After surgery it might take several months for your wrist
to feel completely better. You may need to see a physical or occupational
therapist to help you learn how to use your wrist differently. Then you can go
back to your normal activities. Talk to your doctor about the side effects you
may have from steroid shots or surgery for de Quervain's disease.
The American Academy of Orthopaedic Surgeons (AAOS) provides
information and education to raise the public's awareness of musculoskeletal
conditions, with an emphasis on preventive measures. The AAOS Web site contains
information on orthopedic conditions and treatments, injury prevention, and
wellness and exercise.
Lane LB, et al. (2001). Treatment of de Quervain's
disease: Role of conservative management. Journal of Hand Surgery, 26B(3): 258–260.
Richie CA III, Briner WW Jr (2003). Corticosteroid
injection for treatment of de Quervain's tenosynovitis: A pooled quantitative
literature evaluation. Journal of the American Board of Family Practice, 16(2): 102–106.
Other Works Consulted
Bednar MS, Light TR (2006). Tenosynovitis section of
Hand surgery. In HB Skinner, ed., Current Diagnosis and Treatment in Orthopedics, 4th ed., pp. 555–557. New York:
McGraw-Hill.
Davis JM III, et al. (2009). Wrist and carpal joints
section of History and physical examination of the musculoskeletal system. In
GS Firestein, et al., eds., Kelley's Textbook of Rheumatology, 8th ed., vol. 1, pp. 521–522. Philadelphia: Elsevier
Saunders.
Seiler JG III, et al. (2005). De Quervain
tenosynovitis section of Hand and wrist. In LY Griffin, ed., Essentials of Musculoskeletal Care, 3rd ed., pp. 328–330.
Rosemont, IL: American Academy of Orthopaedic Surgeons.
Swigart CR (2009). Hand and wrist pain. In GS
Firestein, et al., eds., Kelley's Textbook of Rheumatology, 8th ed., vol. 1, p. 658. Philadelphia: Elsevier
Saunders.
Wise C (2008). Hand and wrist pain section of Back
pain and common musculoskeletal problems. In DC Dale, DD Federman, eds.,
ACP Medicine, section 15, chap. 12. New York: WebMD.
Wise C (2009). Therapeutic injection section of
Arthrocentesis and injection of joints and soft tissue. In GS Firestein, et
al., eds., Kelley's Textbook of Rheumatology, 8th ed.,
vol. 1, pp. 722–724. Philadelphia: Elsevier Saunders.
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