×
Clinics in Bedford
Open Mon-Fri 9-5pm

Thumb Tendonitis 

In this article, you will find out about the main causes of thumb tendonitis and the most effective ways to treat the condition and prevent it from returning.

Our hands are one of our body’s most mobile and functional parts, ranking next only to our legs. Without our hands, there is little that we could do efficiently and as skillfully as we do daily, owing to our habits of doing things a certain way. 

However, when one thinks of it, the perfect synchronization of all the fingers makes it possible for us to perform all our tasks and functions effortlessly and flawlessly. Without the involvement of even a single finger, it could become quite difficult for a person to carry out an otherwise harmless task properly. 

Take the example of an injured or broken finger, for instance. There is way too much helplessness that you can experience once that happens – you become dependent on others to perform even the smallest of all jobs, like seriously!  

However, some conditions compromise your functionality, and thus, you have to live with them until they get treated. De Quervain’s tenosynovitis, also known as thumb tendinitis, is one such debilitating condition. 

What Is Thumb Tendonitis? 

Thumb Tendonitis is popularly referred to as ‘De Quervain’s Tenosynovitis’ or ‘De Quervain’s Tendinosis’ in medical terminology. It is an inflammatory condition that commonly starts from the base of the thumb and goes on to involve the inside part of your wrist and even the forearm. [1]

Since all these areas help you with some of the major functions like gripping, holding, and writing – several functions can get compromised when this condition develops. [2]

The name ‘De Quervain’ is named after the French surgeon Fritz De Quervain who first described this condition. In this painful condition, the tendon gets entrapped within the first dorsal compartment of the wrist. [3]

This causes the tendon sheaths to thicken around the thumb side of your wrist – leading to the development of pain on the thumb side of the wrist, which frequently involves the radial and ulnar deviation of the wrist as well which ultimately causes wrist pain to develop. 

What Causes De Quervain’s Tenosynovitis? 

Although there is not a single cause behind thumb tendonitis, some popular causes cause this extremely painful condition to develop and hamper your quality of life. [4]

Some of the most common causes that lead to the development of this De Quervain’s syndrome include the following: 

  • Chronic Overuse:

The most prevalent cause of De Quervain’s tenosynovitis is the chronic overuse of the wrist and thumb. Daily life repetitive activities such as lifting a baby, wringing and hanging clothes, knitting, skiing, and lifting heavy objects can lead to the development of thumb pain and restricted wrist movements. [5]

New mothers are often found to suffer from repeatedly holding and picking up their children throughout the day. 

  • Stress: 

In some of the cases of De Quervain’s tenosynovitis, stress was found to be the causative agent. Although the underlying mechanism behind this cause is unclear, it is also seen to develop during pregnancy, breastfeeding (both due to hormonal changes), and while a person is already suffering from other bone-related conditions such as osteoarthritis, rheumatoid arthritis, etc. [6]

Other causes of thumb tendonitis include being habitual to jobs that require repeated motions of the thumb and wrist, making sure that they both do not relax at all. 

Sometimes, any previous thumb or wrist injury also leads to the formation of scar tissue in the tendon tunnel and compromises the movement or contraction of the thumb and wrist muscles, thus restricting the movement and making it painful. 

A diagram of thumb tendonitis

Symptoms – How Does It Feel Like To Suffer From Thumb Tendonitis? 

While it is obvious that thumb tendonitis is a painful condition, it is equally important for everyone to know what the main characteristic features of this condition are so that they may recognize the condition if they experience any of the following symptoms of De Quervain syndrome or thumb tendonitis: 

  • A feeling of immense pain along with swelling near the base of your thumb that seems to restrict your movements, 
  • A ‘snapping’ feeling near the thumb side of the wrist is felt whenever you move your thumb, 
  • A ‘squeaky’ sound is commonly heard as the inflamed tendon moves over its fibrous sheath, 
  • Tenderness over the affected area along the base of your thumb,
  • Stiffness of the affected region. 

The symptoms of De Quervain’s syndrome vary from person to person. So does their severity and occurrence pattern. 

However, one thing is for sure – anyone who has developed this highly painful condition is bound to experience great disability when it comes to performing their daily life activities with ease.  

It is also seen that thumb tendonitis develops majorly in females in their middle ages, that is, between the ages of 40 to 50. 

Evaluation and Diagnosis of Thumb Tendonitis: 

The evaluation and diagnosis of thumb tendonitis are only made after a doctor’s complete examination of the affected area. No imaging techniques (X-Ray, MRI) are involved throughout the process since the clinical diagnosis is much more reliable, and the problem can be diagnosed immediately. 

Finkelstein’s Test: 

The doctors use this test to diagnose De Quervain’s tenosynovitis in the clinics. [7]

Finkelstein’s Test involves the following steps: 

  • Bend your thumb such that it rests across the palm of your hand. 
  • Then gently, make a fist out of this hand in such a manner that your fingers come to lie across this thumb. It would help if you take care not to move the thumb during this stage or bring it to lie over the fingers. 
  • With this fist made, now slowly bend your wrist towards your ‘pinky’ or little finger. 
  • Suppose you suddenly experience pain or tenderness around the base of your thumb or, more appropriately, around the wrist region. In that case, it is confirmed that you are indeed suffering from thumb tendonitis. 

Treatment Options For Thumb Tendonitis

Usually, the thumb tendonitis condition is seen to resolve in no time. However, when a person takes adequate rest and immobilizes the thumb and wrist region for some time, they can very easily notice visible differences in their pain and restricted movements. 

And this does not stop here only. Several muscles, ligament, and tendon-related conditions within the arm region get resolved using the same treatment options, including trigger finger, carpal tunnel syndrome, and others. 

The American Academy of Orthopaedic Surgeons suggests that conditions such as De Quervain’s syndrome can be easily treated using conventional, non-surgical methods. [8]

Some of the most commonly employed treatment options for De Quervain’s disease are as follows:  

Splinting for thumb tendonitis: 

Specifically for thumb tendonitis, soft spica splints are designed to restrict thumb and wrist movements. However, the type of splint that people may use depends on their range of motion and the frequency of their symptoms. [9]

Usually, a soft splint is used for people suffering from occasional or mild symptoms, whereas a more rigid and restrictive splint is used for patients with persistent symptoms. 

Applying a splint is considered the first-line treatment for patients with thumb tendonitis and other thumb and wrist-related abnormalities. 

Physical Therapy: 

Interestingly enough, several hand therapy exercises exist to ensure that the thumb does not become immobile or restricted over time. The affected person can easily do these simple exercises at home or go to a physiotherapist to do them under their supervision. 

Usually, some hands-on manipulation, stretching, and muscle-strengthening exercises seem to do the work for you. 

It is also important for the irritated tendons to be provided with an optimal amount of relaxation so that they do not become more inflamed over time. 

Anti-Inflammatory Medications: 

Along with lifestyle changes, it is also important for the affected person to take some healthcare professional’s medical advice and get some appropriate anti-inflammatory medication to relieve the inflammation, tenderness, and swelling from the affected area.  

It is recommended that over-the-counter NSAIDs such as Ibuprofen (Advil, Tylenol) and Naproxen (Apronax) can help resolve the thumb pain to some extent. However, combining this intake of NSAIDs with splinting or physical therapy can have an even better effect. 

Steroid Injections: 

Corticosteroid injections have been proven to significantly improve and even completely resolve the symptoms of thumb tendonitis. It was seen that a course of two injections in the majority of the patients helped in resolving the symptoms of thumb tendonitis completely. [10]

The corticosteroid injection is meant to deliver and infiltrate the sheaths of extensor pollicis brevis and abductor pollicis longus as deeply as possible to yield maximum results. Within the first dose, 50% of symptoms were seen to disappear, which further resolved after the second dose. 

Prolotherapy

Some structures have a poor blood supply, which is why they can struggle to heal on their own. It is the oxygen and nutrients in our blood supply that help to heal these structures.

Prolotherapy involves the injection of a regenerative solution into these structures to provide a direct supply of what is needed to heal them and provide pain relief.

As the treatment is helping to treat the root cause of the problem, it is deemed to be a permanent fix.

Surgical Treatment for thumb tendonitis: 

A tendon release surgery is performed in persistent cases of thumb tendonitis or where it seems impossible to achieve remission with conventional treatments. [11]

In this surgical method, an incision is made in the wrist near the base of your thumb. Then, the tissues and the sheaths overlying the swollen, inflamed, and irritated tendons are removed so as to release the tension or compression that these tendons were placed under.  

If there is excess tissue, the surgeon removes it to make space for the existing structures to coexist peacefully and without any restricted movements. [12]

This surgery helps release the tension and so relieves the pain that the person was suffering from throughout the condition. 

Conclusion

Thumb Tendonitis or De Quervain’s Tenosynovitis is a treatable and manageable condition. Although it can be very painful and lead to the development of restricted hand movements, it can be resolved and treated in no time if it is diagnosed on time. 

This condition develops due to chronic overuse of the hands and in the majority of cases, women, gamers, and people who have to type or write for prolonged hours are seen to suffer from this condition. 

 

Frequently asked questions

  1. How Long Does Thumb Tendonitis Take To Heal?

If diagnosed early and if the management protocols – such as splinting and NSAIDs, are started as soon as possible, then it is seen that the symptoms of this painful thumb condition can resolve easily within six weeks. 

  1. How Long Does It Take For De Quervain’s Tendonitis To Heal?

De Quervain’s tenosynovitis is accompanied by considerable swelling and inflammation around the base of the thumb and wrist region. Therefore, it takes some time for the condition to resolve and reverse to normal. Usually, De Quervain’s tenosynovitis can resolve within 4 to 6 weeks of persistent treatment. 

  1. Should I Massage Tendonitis?

Yes! Massaging the inflamed area will always help in exerting a calming and soothing effect. It is also seen that along with medical treatment, if conventional methods such as massaging the inflamed area are done, it can help speed up the healing and recovery process. 

  1. What Happens If De Quervain’s Tenosynovitis Goes Untreated?

When left unresolved and untreated, several complications can occur, making it difficult for the inflamed tendons to assume their normal position. Usually, the pain starts spreading further – towards the forearm area. 

If such conditions persist, then the person may also become unable to perform such activities as pinching, holding, and grasping objects precisely. 

  1. What Is The Main Difference Between Carpal Tunnel And De Quervain’s?

Both De Quervain’s Disease and Carpal Tunnel Syndrome are similar in some aspects. Both De Quervain’s Disease and Carpal Tunnel Syndrome are similar in some aspects. For example, both are accompanied by swelling, pain, and tendon inflammation. Both conditions also occur due to similar, repetitive motions of the thumb and wrist region.

However, the main difference is the presence of a characteristic numbness and tingling in Carpal Tunnel Syndrome, which is absent in De Quervain’s disease. 

  1. Is It Better To Ice Or Heat Tendonitis?

Since thumb tendonitis is a chronic condition, it is better to use heat over it. However, cold compresses usually work best for acute, short-term conditions and might not as effectively exert their impacts on swollen and inflamed tendons as the heat would. 

References 

  1. Satteson E, Tannan SC. De Quervain Tenosynovitis. [Updated 2022 Feb 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK442005/
  2. Baabdullah, A., Bokhary, D., Kabli, Y., Saggaf, O., Daiwali, M., & Hamdi, A. (2020). The association between smartphone addiction and thumb/wrist pain: A cross-sectional study. Medicine, 99(10).
  3. Goel, R., & Abzug, J. M. (2015). de Quervain’s tenosynovitis: a review of the rehabilitative options. Hand (New York, N.Y.), 10(1), 1–5. https://doi.org/10.1007/s11552-014-9649-3
  4. Patel, K. R., Tadisina, K. K., & Gonzalez, M. H. (2013). De Quervain’s Disease. Eplasty, 13, ic52.
  5. Stahl, S., Vida, D., Meisner, C., Stahl, A. S., Schaller, H. E., & Held, M. (2015). Work related etiology of de Quervain’s tenosynovitis: a case-control study with prospectively collected data. BMC musculoskeletal disorders, 16, 126. https://doi.org/10.1186/s12891-015-0579-1
  6. Maruyama, M., Takahara, M., Kikuchi, N., Ito, K., Watanabe, T., & Ogino, T. (2009). De Quervain disease caused by abductor pollicis longus tenosynovitis: a report of three cases. Hand Surgery, 14(01), 43-47.
  7. Som A, Wermuth HR, Singh P. Finkelstein Sign. [Updated 2021 Oct 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539768/
  8. Larsen, C. G., Fitzgerald, M. J., Nellans, K. W., & Lane, L. B. (2021). Management of de Quervain Tenosynovitis: A Critical Analysis Review. JBJS reviews, 9(9), e21.
  9. Nemati, Z., Javanshir, M. A., Saeedi, H., Farmani, F., & Aghajani Fesharaki, S. (2017). The effect of new dynamic splint in pinch strength in De Quervain syndrome: a comparative study. Disability and Rehabilitation: Assistive Technology, 12(5), 457-461.
  10. Başar, B., Aybar, A., Basar, G., & Başar, H. (2021). The effectiveness of corticosteroid injection and splint in diabetic de Quervain’s tenosynovitis patients: A single-blind, randomized clinical consort study. Medicine, 100(35).
  11. Garçon, J. J., Charruau, B., Marteau, E., Laulan, J., & Bacle, G. (2018). Results of surgical treatment of De Quervain’s tenosynovitis: 80 cases with a mean follow-up of 9.5 years. Orthopaedics & Traumatology: Surgery & Research, 104(6), 893-896.
  12. Mangukiya, H. J., Kale, A., Mahajan, N. P., Ramteke, U., & Manna, J. (2019). Functional outcome of De Quervain’s tenosynovitis with longitudinal incision in surgically treated patients. Musculoskeletal surgery, 103(3), 269-273.

Read more: