De Quervain Disease

GENERAL INFORMATION:

What is de Quervain's disease? De Quervain's (kar-VAZ) disease is also called tenosynovitis of the wrist or washerwoman's sprain. It is a condition affecting the tendons that control the thumb. Tendons are cords of tissue that connect muscles to the bones. These tendons are enclosed in a protective sheath (covering). With de Quervain's disease, the sheath becomes narrow and the tendons thicken. This may later lead to pain in the affected thumb, wrist, or hand. De Quervain's disease usually affects women and those over 40 years of age. With treatment, such as rest, medicines, and a splint, you may be able to resume your normal daily activities.

What causes de Quervain's disease? De Quervain's disease is usually caused by frequent, repeated movements of your thumb or wrist. Activities that can cause this condition include sewing, typing, piano playing, knitting, and weaving. A direct blow to the thumb may also damage the tendon and form scar tissue. This scar tissue can make the tendon thick and unable to stretch or move very well. Lifting small children and playing sports, such as wrestling or bowling, may make the condition worse. It can also be caused by inflammatory arthritis, such as rheumatoid arthritis.

What are the signs and symptoms of de Quervain's disease? Signs and symptoms usually appear when there has been an increase in activity of the hand, especially the thumb. You may have pain and swelling in your thumb or the wrist below the affected thumb. This pain usually occurs when moving the wrist up and down, while grasping an object, or making a fist. Over time, the pain may become worse and may be present even at rest. There may be a grating sound or feeling when the hand is moved or rubbed. You may also have weakness and limited movement of the thumb or wrist.

How is de Quervain's disease diagnosed? You may need any of the following:

• Physical exam: Your caregiver may have you make a fist with your thumb touching the palm of your hand. Your palm is the inside of your hand. While your hand is in this position, he will ask you to move your hand and wrist in certain directions. Your caregiver will check to see if you have pain, weakness, or any movement problems. Both hands may need to be checked for any pain or movement problems.
  
  
• X-rays: You may need x-rays of your wrist, hand, and forearm to check for broken bones or other problems. X-rays of both your painful and non-painful hands and wrists may be taken.
  
  
• Magnetic resonance imaging scan: This is also called an MRI. An MRI uses magnetic waves to take pictures of the forearm, wrist, and hand area. This may help your caregiver decide if you have de Quervain's disease, or another condition that is affecting your hand and wrist.

How is de Quervain's disease treated? Treatment will depend on your symptoms and the length of time you have had them. Your caregiver may want you to limit movement of your affected hand or thumb to decrease stress on the tendon. This may help prevent further damage, decrease pain, and promote tendon healing. You may also have one or more of the following:

• Immobilization: Immobilization (keeping your wrist from moving) is an important treatment that allows the wrist to heal.
  
  
• Medicines: Your caregiver may give you medicines to decrease the pain and swelling in your hand, wrist, or thumb. These medicines may be given by mouth or as a shot in your wrist.
  
  
• Splint: A splint may be used on your thumb and wrist to decrease pain and prevent the tendons from being damaged further.
  
  
• Surgery: You may need surgery if your symptoms do not go away with treatment, such as medicine. Surgery may also be done if your pain gets worse or is so severe (bad) that it affects your daily activities.
  
  
• Rehabilitation: This is a program that may include physical and occupational therapy to help your condition heal faster. When the swelling has gone down, you may be given exercises to do. These exercises aim to bring back the normal range of motion of your hand or thumb, and will also strengthen your tendons. Your caregiver may also ask you to make changes in your activities to decrease stress on the tendons. These changes may also prevent this condition from happening again.

Where can I find support and more information? Having de Quervain's disease may make it hard for you to continue your usual activities. It may make things difficult for both you and your family. Contact the following for more information:

• American Academy of Family Physicians
  PO Box 11210
  Shawnee Mission, KS 66207-1210
  Phone: 1-913-906-6000
  Web Address: http://www.aafp.org
  

• American Academy of Orthopaedic Surgeons
  6300 North River Road
  Rosemont, IL 600184262
  Phone: 1-847-8237186
  Web Address: http://www.aaos.org/
  

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

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