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De Quervain’s Tenosynovitis

This is a painful condition that tends to affect the tendons in the wrists of people who commonly work with their hands. The condition occurs due to chronic overuse of the wrist and thumb, as well as repetitive, improper use of the wrist joint.

The swelling caused by such overuse leads to sheaths forming over the tendons, which rub against one another, resulting in swelling of the wrist and thumb.  

High Risk Groups
  1. People who rely on their hands for work, including office workers who use computers or smartphones for prolonged periods, cleaners, chefs, engineers, agricultural workers, and those who are required to lift heavy objects regularly.
  2. Those who engage in activities that require extensive use of the wrist, such as athletes from certain sports, weightlifters, people in musical bands, people who hold infants in their arms regularly, seamstresses, or those that execute manual tasks, such as hammering, screwing, or hand laundering clothes.
  3. Obese groups and women, who are more susceptible than men.
  4. Pregnant and breastfeeding women, whose hormones are undergoing significant changes.
  5. Patients suffering with rheumatoid arthritis, thyroid disorders, or diabetes.
 
Symptoms
The condition generally involves pain at the base of the thumb when the thumb or wrist on that hand is in use. Should the condition remain untreated, the pain may spread from the thumb to the forearm, becoming more painful in the mornings and often involving numbness or swelling, redness, and a burning sensation in the thumb when pressure is applied.

 
Treatment
  1. Completing a course of medication, resting the hands, and using a wrist support that covers the base of the thumb can all be effective in treating the condition in its early stages.
  2. Should the condition not improve or if it further deteriorates after 2–3 weeks, patients may require steroid injections at the affected site. The pain should recede following such injections and the hand may be used as usual, although there is a high chance of the condition making a return once the hand is used regularly again.
  3. In cases involving repeated bouts of the condition or in cases that do not improve despite treatment, surgery may be considered. The procedure involves a local anesthetic being administered into the affected area, followed by the removal of the sheaths covering the tendons. There is no need for an overnight stay in hospital, while the surgery usually provides a cure for the condition, meaning that the chances of it making a return are minimal.

Authors: Dr. Surachai Rattanasaereekiat is an orthopedic surgeon at Orthopaedic Center Bumrungrad. Dr. Surachai is currently a hand and trauma Specialist at Bumrungrad, specializing in upper extremity and trauma fracture surgery.


 
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