Sore wrist (de Quervain's tendonitis)

What is de Quervain's tendonitis?

The tendons along the thumb side of the wrist are attached to the muscles of the thumb, controlling its movement, especially when you're using your thumb to grasp things.

Stress put on these grasp tendons can cause trauma at a microscopic level to the tendon tissues, causing them to swell and become inflamed. The end result is stiffness and pain, especially when you form a fist, try to grip things or turn your wrist (for example, when opening a door). This condition is known as de Quervain's tendonitis.

Symptoms

• Pain over the thumb side of the wrist, which may start slowly or suddenly. The pain may extend right up into the arm, and is worse when you try to move the hand and thumb, especially when twisting the wrist. If you press the tendons on the thumb side of the wrist, they'll be very tender.
• Swelling of the area is typical and can make movement very stiff and limited.
• Sometimes a small cyst forms.
• A sensation of something 'catching' or not moving smoothly when you try to use your thumb.
• More rarely, an area of numbness on the thumb and first finger may develop because of irritation of nerves.

One useful test for de Quervain's is to make a fist by bending your thumb and wrapping the other fingers over it, then tilt your wrist towards the little finger. This is known as the Finkelstein test, and if you have de Quervain's then it's very painful.

Treatment and recovery

Treatment consists of measures to reduce the irritation and inflammation of the tendons.

First, avoid the activities that caused the problem. This may be enough, but you should also rest the thumb and wrist, ideally by wearing a splint to prevent movement.

Anti-inflammatory painkillers such as ibuprofen should be taken regularly as directed on the packet. Your doctor may also give you an injection of anti-inflammatory medication (a steroid injection, sometimes with an anaesthetic agent for the pain) directly into the affected area.

In more severe cases, an operation may be necessary to relieve pressure and irritation in the area.