Thursday, April 23, 2009

Work Related de Quervain's Tendonitis

The condition known as de Quervain's tendonitis, or tenosynovitis, results from the tendons at the base of the thumb becoming irritated or inflamed. When the tendon gets inflamed, the tunnel that surrounds it swells, and it becomes painful to move the thumb or wrist. Those who suffer from de Quervain's tendonitis feel pain when they hold things or try to form a fist.
De Quervain's Tendonitis

Causes of De Quervain's Tendonitis
Formally known as first dorsal tendonitis, de Quervain's tendonitis is caused when the tendons at the thumb's base become irritated, usually as a result of a new repetitive activity. It is a frequent complaint from new mothers, who need to care for their babies with awkward hand positions they are not familiar with. Furthermore, changes in hormone levels from pregnancy and nursing add to the possibility of the condition showing up in new mothers.

A change to the way the wrist normally works and moves because of a fracture, severe strain or overuse in the work place can also trigger de Quervain's tendonitis because of the new and unusual stress the tendons may incur.

Signs & Symptoms
The main symptom of de Quervain's tendonitis is pain in the side of the wrist near the thumb. The pain might show up either suddenly or over time, but is felt in the wrist's first dorsal compartment. The pain can run up the forearm or down into the thumb. Moving the hand or thumb makes it worse, especially if they are twisted or used to hold onto something firmly.

Pain of the Thumb

The base of the thumb may become swollen and a cyst filled with fluid may even appear. The thumb, when moved, may sometimes catch or pop, and it may be hard to pinch. The nerve that lies on top of the tendon's sheath or tunnel may also become irritated and cause the index finger and back of the thumb to become numb.

Diagnosis of Tendonitis
Your hand surgeon will carefully examine your hand and wrist for signs of de Quervain's tendonitis and check if the tendons at the base of the thumb are tender. To test for it, you may be asked to make a fist with your thumb inside your fingers and your hand surgeon may then try to gently bend your fist toward your little finger. If you have de Quervain's tendonitis, this movement will cause pain.

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Non-Surgical & Surgical Treatments
Your hand surgeon will treat the condition so that your pain is removed or lessened by reducing the irritation and swelling in the affected tendons. Your hand doctor may suggest that you wear a splint to rest your thumb and wrist and may recommend some anti-inflammatory medications. Sometimes the inflammation can be relieved by a shot of cortisone or other steroid, and any of these treatments can reduce the swelling and pain. Changing or eliminating the motions that cause the pain can also get rid of them.

If the symptoms are very severe or the treatments tried so far don't work, surgery can often help. During the surgery, your hand surgeon will open up the compartment to give the inflamed tendons more room to move. This procedure eliminates the inflamed tendons swelling even further, which in turn increases the inflammation, and so on. Following the surgery, a splint may be suggested, but once comfort and strength have returned, normal hand, wrist, and thumb function will come back.