De Quervain's Disease

What is de Quervain's disease?

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.
• Put ice on the area that hurts or is swollen for 15 minutes every 4 to 6 hours. Put a thin cloth between the ice and your skin.
• 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's 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.

• Carpal Tunnel Syndrome
• Finger, Hand, and Wrist Injuries
• Finger, Hand, and Wrist Problems, Noninjury
• Osteoarthritis
• Rheumatoid Arthritis

Citations

1. Lane LB, et al. (2001). Treatment of de Quervain's disease: Role of conservative management. Journal of Hand Surgery, 26B(3): 258–260.

2. 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 (2003). Tenosynovitis section of Hand surgery. In HB Skinner, ed., Current Diagnosis and Treatment in Orthopedics, 3rd ed., p. 546. New York: Lange Medical Books/McGraw-Hill.

• Johnson TR, et al. (2001). De Quervain tenosynovitis section of Hand and wrist. In WB Greene, ed., Essentials of Musculoskeletal Care, 2nd ed., pp. 232–234. Rosemont, IL: American Academy of Orthopaedic Surgeons.

• Moder KG, Hunder GG (2005). Wrist and carpal joints section of History and physical examination of the musculoskeletal system. In ED Harris Jr et al., eds., Kelley's Textbook of Rheumatology, 7th ed., vol. 1, pp. 489–490. Philadelphia: Elsevier Saunders.

• Swigart CR, Wolfe SW (2005). Radial wrist and base of thumb pain section of Hand and wrist pain. In ED Harris Jr et al., eds., Kelley's Textbook of Rheumatology, 7th ed., vol. 1, p. 631. Philadelphia: Elsevier Saunders.

• Wise C (2005). Therapeutic injection section of Arthrocentesis and injection of joints and soft tissues. In ED Harris Jr et al., eds., Kelley's Textbook of Rheumatology, 7th ed., vol. 1, p. 695. Philadelphia: Elsevier Saunders.