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De Quervain’s disease

This is a condition which causes pain on the inside of the wrist near the base of the thumb. It is caused by tendinitis in one or two of the tendons which move the thumb away from the hand.

These tendons glide in sleeve-like tubes, or tendon sheaths near wrist on the thumb side. When these tendons become swollen inside the sleeves, or the lining of the sleeves becomes swollen, tendinitis occurs. This increases friction and inflammation,causing pain.

Pain is experienced on the thumb side of the wrist with certain motions (making a fist, spreading the thumb away from the hand, pinching objects or twisting the wrist such as when wringing out a towel). There also may be swelling and tenderness in that area.

Overuse of the thumb or unusual new activities may cause de Quervain’s tendinitis. It has sometimes been called ‘Mommy thumb’, as it is frequently seen in new mothers. Women develop this much more frequently than men. Other conditions such as rheumatoid arthritis may cause swelling in the tendon sleeve, and cause De Quervain’s syndrome.

Usually the diagnosis is made by performing a test called the Finkelstein manoeuvre. The fist is closed around the thumb, and the wrist is moved sideways toward the little finger, causing pain. Trying to hold the thumb spread out against resistance is often painful. The tendon near the side of the wrist also may be swollen and tender.

Resting the hand or changing painful activities may be successful. Medications called ‘non-steroidal anti-inflammatory medications (or ‘NSAIDs’ for short) are commonly recommended. Some of the more commonly prescribed of these include medications such as Celebrex, Motrin or Naprosyn (a complete list is available at the reference below). Physical therapy may offer additional treatment, and thumb splints may be helpful. If these are not successful, or if the tendon is very swollen, injections with a cortisone-like medication may be very helpful. If left untreated, surgery may be necessary to stop the pain and improve thumb function.

Additional Resources:
Finkelstein test NSAID information
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