Hand & Wrist: DeQuervain Syndrome


DeQuervain syndrome is a condition where the tendons that straighten the thumb become painful as they pass through a narrow tunnel located along the thumb side (radial side) of the wrist, called the first dorsal compartment. The soft tissues that make up the tunnel and/or the sheath surrounding the tendons can become thickened, constricting the tendons and causing pain.

Causes of DeQuervain syndrome?

The exact cause of DeQuervain syndrome is not always known. Some possible causes of  include:

  • Cumulative microtrauma – a repeated, sustained, or forceful thumb and wrist motion may contribute to symptoms. Examples of activities that may lead to microtrauma are: opening jars, wringing out wash cloths, cutting with scissors, playing the piano or crocheting
  • Acute trauma – occasionally an acute injury will lead to symptoms, thought this is less common. Examples of acute trauma that may caused a sudden onset of symptoms include: a sudden wrenching of the wrist, or a fall onto an outstretched hand 
  • Gender – women are more susceptible than men by at least a 4 to 1 ration.
  • New and nursing mothers – symptoms often start four to six weeks after delivery.



Signs and symptoms of an DeQuervain Syndrome may include:
  • Pain along the radial side of the wrist
  • Pain may be sharp, dull or achy and may radiate into the thumb or forearm
  • Increased pain with motion and use - especially with gripping and twisting
  • Swelling along the radial wrist
  • Occasionally an increased prominence develops at the radial wrist
Activity Modification

Changing or avoiding symptoms provoking activity may help reduce pain. Using different equipment - such as ergonomic keyboards, tools with pistol grips, or a key holder - will help reduce stress to the tendons and soft tissue.

Splint or Brace

A splint or brace will help limit or stop the motion of the wrist and thumb which allows soft tissues to rest.

Medications

Anti-inflammatory such as acetaminophen (Tylenol), ibuprofen (Advil), or naproxen
(Aleve) may help manage pain. Follow dosage recommendations on the label.

Hand Therapy

A Certified Hand Therapist can provide education and strategies for activity modification, a splint to allow for soft tissues to rest and prevent motion that causes pain, and a home program of stretching and strengthening exercises. Therapists may also use different modalities, such as ultrasound or soft tissue mobilization, to help reduce pain.

Cortisone Injection

An injection of anti-inflammatory medicine into the tendon compartment may help decrease pain. Response to the injection will vary from person to person.

Surgery

When non-surgical treatment has not provided adequate relief of symptoms, surgery may be recommended to open the first compartment and make more room for the tendons. A consultation with your hand surgeon can help decide the best course of treatment for you.

DeQuervain Syndrome, TRIA Orthopaedic Center, Bloomington, MN  

DeQuervain Syndrome DeQuervain Syndrome DeQuervain Syndrome DeQuervain Syndrome

drawing of the first dorsal compartment, De Quervain's Syndrome, TRIA Orthopaedic Center
A drawing of the first dorsal compartment
Dorsal Compartments, De Quervain's Syndrome, TRIA Orthopaedic Center
The first dorsal compartment – There are six compartments on the dorsal or back side of the wrist. The first and third compartments house tendons that control the thumb
De Quervain's Syndrome, TRIA Orthopaedic Center
Pain with this motion, a hammering motion with the thumb in the fist, is characteristic of de Quervain syndrome

Courtesy of American Society for Surgery of the Hand