Thumb Pain – De Quervain Tenosynovitis
De Quervain Tenosynovitis is a painful condition involving the tendons of the thumb. It greatly limits any activity that requires the use of the thumb, especially movements like grasping or gripping. Recently De Quervains Tenosynovitis has also been affectionately called ‘Blackberry Thumb’, ‘Iphone Thumb’ or ‘Gamer’s Thumb’ since this condition is often seen in those with excessive mobile phone or tablet use.
What is De Quervain Tenosynovitis?
Thumb movements are supported by two main muscles that insert at the base of the thumb. Generally, any repetitive movements that add stress or strain on the thumb tendons can cause microscopic damage to the muscle fibers. Once the fibers have been damaged, they become inflamed, and can begin to degenerate. This degeneration can also spread to the tendon sheath and thumb compartment area, leading to tenosynovitis.
De Quervain Tenosynovitis is seen more frequently among middle age men and women (women more commonly than men, however). The peak age of incidence is 30 to 50 years.
Sign and symptoms:
The classic signs and symptoms of De Quervains are normally limited to thumb and surrounding area, and include:
– Moderate to severe pain around the base of thumb
– Mild to moderate swelling after any movement that involves thumb like pinching or grasping
– Weakness of any action or movement that involves participation of thumb
– The classic sensation of “stop and go” in the thumb during voluntary movements
How does it develop?
The thumb is one of the essential elements in any activity that involves the hand or wrist. Chronic abuse or poorly regulated use of the wrist can cause De Quervain Tenosynovitis, as activities that involve repeated movements or stimulation of the thumb muscles can lead to irritation of the protective sheath around the tendons. If the activity is not restricted after initial episodes of irritation, long-standing infection and inflammation may lead to sclerosis or thickening of tendon sheaths. This can greatly limit or restricts thumb movement.
Some potential risk factors that may increase tendon damage are:
– Direct trauma or injury that may lead to scarring of the tendon
– Certain inflammatory joint conditions such as rheumatoid arthritis that can limit the activity due to synovial tissue destruction
– Certain physiological conditions such as pregnancy that affects the integrity of all small joints due to alteration in the level of different hormones
– Repeated hand movements with certain occupations like gardening, or sports such as golf, tennis, or squash
– Many cases are developed during caring for a newborn baby due to repeated lifting of the baby without supporting the thumb properly.
If not treated in a timely manner, De Quervains may also involve the dorsal aspect of thumb and index finger.
