What do politicians, massage therapists, musicians, card dealers, carpenters, cooks and painters have in common? They use their thumbs and twist their wrists a lot and commonly have pain at the base of the thumb or on the side of the wrist caused by tendonitis.
Tendons, which are tough, fibrous, rope-like tissues that link muscles to bone, are one of the most commonly injured structures in the body. The more severe the injury, the more fiber is torn, thus the more pain is felt. Tendonitis, which means “tendon inflammation,” takes a long time to heal because of a lack of abundant blood supply. When tendons are re-injured, tears can recur and form scar tissue, making healing difficult. With chronic tendonitis, tendon sheaths become thick and limited, which allows for the formation of nodules or knots.
De Quervain’s disease, first diagnosed by Felix De Quervain in 1895, occurs with overuse of the thumb while moving the wrist, in such movements as excessive hand-shaking, gardening, scooping ice cream, or using a screwdriver. Because of tendon inflammation, patients experience constant dispersed pain at the inner side of the wrist (radial styloid), which is worse with repetitive motion and can radiate into the thumb and up the lower arm. Commonly, De Quervain’s tendonitis affects women in their 30s and 40s and after pregnancy. With chronic De Quervain’s, nodules can form and act like knots in a rope passing through a pulley, consequently causing the thumb to lock in a certain position, known as “trigger thumb.” The Finkelstein’s test, which, when positive, shows increased pain upon forced ulnar deviation (folding the thumb into your palm pointing the hand toward your pinky), can be performed as a test for De Quervain’s tendonitis.
Initial treatment of the pain usually includes a combination of NSAIDs (non-steroidal anti-inflammatory drugs) and physical therapy. Local heat and ice applications may be beneficial, as well as wearing a nighttime thumb splint for immobilization. Avoiding repetitive activity that can induce or aggravate your symptoms is essential. Finally, of benefit are corticosteroid injections into the tendon sheath, which requires precise needle position and specific technique to avoid damage to the tendon or nerve. As in many circumstances, other conditions can show similar symptoms that must be differentiated prior to beginning treatment. With osteoarthritis of the CMC joint (where the thumb pivots on the wrist), pain can also be felt upon gripping. However, the difference between these two conditions is that osteoarthritis involves the joint while De Quervain’s affects the tendon, an important difference. Play an active role in managing your health and know what differences are important.
