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De Quervain's tenosynovitis

(Gamer's thumb)

De Quervain tenosynovitis is a painful condition that affects the tendons of the thumb side of the wrist. Commonly associated with sports and occupations that involve tight gripping/ twisting movements of the wrist, and new mothers caring for their infants, de Quervain is now recognized as a common cause of wrist pain in video gamers of all ages.

What is de Quervain's tenosynovitis?

De Quervain (pronounced dih-kwer-VAIN) tenosynovitis develops when the two tendons around the base of the thumb (abductor policis longus and extensor policis brevis) become constricted and inflamed by the thickening of the band of connective tissue (the extensor retinaculum) that normally functions to stop the tendons from bowstringing when you move them. This is similar to what happens when you get a trigger finger, only this is on the back (first extensor compartment) of the wrist.

The exact cause is not clear but we believe it is the result of overuse of the wrist and thumbs.

Who gets de Quervain tenosynovitis?

  • Women are 8-10 times more likely than men to develop the condition.  Mothers of newborns are particularly prone. It's not clear if this is due to the hormonal changes that occur around pregnancy or activities associated with infant care.
  • Individuals who play sports or activities where you have to grip tightly, such as golf and racquet sports.
  • People who type or knit for long periods.
  • Video gamers - Using the joystick on a console controller or "thumbing" a touch screen is more likely to cause the condition over using a keyboard and mouse.

What are the symptoms of de Quervain tenosynovitis?

At first, you may only notice pain or stiffness around the thumb side of your wrist that comes on gradually after a prolonged period of repetitive activity like video gaming.

This may develop into severe pain when you perform actions like gripping and raising objects with your wrist in a neutral/straight position, such as lifting your baby out of a bath or cot.

If not attended to early a swelling can develop at the site of the pain.

How do you diagnose de Quervain tenosynovitis?

De Quervain is easily diagnosed by your doctor by taking a careful history and performing a physical examination.

A useful test you can try yourself is Eichoff's test: make a fist wrapping your fingers around your thumb then gently angle your wrist down away from your thumb. Be careful, this can be very painful!

When you attend your appointment an in-clinic ultrasound scan may be used to help confirm the diagnosis.

Treatment options for de Quervain tenosynovitis

The first line of treatment you can try at home is to rest the wrist through activity modification and wearing a wrist/thumb splint.

You can apply ice packs for pain relief and or take nonsteroidal anti-inflammatory medication, if you are able to, and have taken guidance from an appropriate healthcare professional.

Corticosteroid injection into the extensor tendon sheath is very effective at resolving pain and reversing swelling over the tender area. Steroid injection alone has a cure rate of 83% compared to 14% for splinting.

For cases that do not respond to non-operative treatment, surgery is recommended.

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