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De Quervain Syndrome

(De Quervain's Syndrome; Washerwoman’s Sprain)

By David R. Steinberg, MD, Associate Professor, Department of Orthopaedic Surgery, and Director, Hand and Upper Extremity Fellowship, Perelman School of Medicine at the University of Pennsylvania

De Quervain syndrome is swelling and inflammation of the tendons or tendon sheaths that move the thumb outward.

De Quervain syndrome usually occurs after repetitive use, particularly wringing, of the wrist. It often develops in new mothers, probably because they repeatedly pick up their baby by stretching out their arms and using only their wrists. It can also develop with rheumatoid arthritis.

The main symptom of De Quervain syndrome is aching pain on the thumb side of the wrist and at the base of the thumb, which becomes worse with movement. The area at the base of the thumb near the wrist is also tender.

Doctors diagnose De Quervain syndrome when they detect tenderness over the two tendons on the thumb side of the wrist, usually accompanied by swelling. To detect tenderness, doctors have people bend their thumb into their palm and wrap their fingers over the thumb. Then people bend their wrist away from the thumb. People are likely to have De Quervain syndrome if this movement causes pain at the same side of the wrist as the thumb.

New mothers may be able to avoid this disorder if they use their entire arm and hold their wrists straight when they lift their baby.

Treatment

  • Corticosteroid injection

  • Thumb splint

  • Sometimes surgery

Movements that cause pain should be avoided. Rest, warm soaks, and nonsteroidal anti-inflammatory drugs (NSAIDs) may help people with mild symptoms.

People with more severe symptoms usually feel better after treatment with a corticosteroid injection and a thumb splint. Sometimes one or two more injections, separated by several weeks, are needed.

If these methods do not relieve symptoms, people may need surgery to free the tendon.