Monday, January 16, 2017

Know About de Quervain’s Tenosynovitis

De Quervain’s tenosynovitis occurs when the 2 tendons around the base of your thumb become swollen. The swelling causes the sheaths (casings) covering the tendons to become inflamed. This puts pressure on nearby nerves, causing pain and numbness.

Symptoms Of de Quervain’s Tenosynovitis
- Pain or tenderness at the base of your thumb
- May feel pain going up to forearm
- Swelling near the base of your thumb
- A fluid-filled cyst in the affected area, which may or may not bulge through your skin
- Numbness along the back of your thumb and index finger
- A “catching” or “snapping” feeling when you move your thumb
- A squeaking sound as the tendons move within the swollen sheaths

Why It Happend?
Chronic overuse of your wrist is commonly associated with de Quervain's tenosynovitis.
Tendons are rope-like structures that attach muscle to bone. When you grip, grasp, clench, pinch or wring anything in your hand, two tendons in your wrist and lower thumb normally glide smoothly through the small tunnel that connects them to the base of the thumb. Repeating a particular motion day after day may irritate the sheath around the two tendons, causing thickening and swelling that restricts their movement.
Other causes of de Quervain's tenosynovitis include:
- Direct injury to your wrist or tendon; scar tissue can restrict movement of the tendons
- Inflammatory arthritis, such as rheumatoid arthritis

Risk factors for de Quervain’s Tenosynovitis
- Age. If you're between the ages of 30 and 50, you have a higher risk of developing de Quervain's tenosynovitis than do other age groups, including children.
- Sex. The condition is more common in women.
- Being pregnant. The condition may be associated with pregnancy.
- Baby care. Lifting your child repeatedly involves using your thumbs as leverage and may also be associated with the condition.
- Jobs or hobbies that involve repetitive hand and wrist motions. These may contribute to de Quervain's tenosynovitis.

How is de Quervain’s tenosynovitis diagnosed?
To diagnose de Quervain’s tenosynovitis, your doctor may do a simple test called the Finkelstein test. First, you bend your thumb so it rests across your palm. Then you make a fist, closing your fingers over your thumb. Last, you bend your wrist toward your little finger. If you have tenderness or pain at the base of your thumb, you probably have de Quervain’s tenosynovitis.

Complications
Untreated de Quervain's tenosynovitis might make it hard to use your hand and wrist properly and limit your wrist's range of motion.

How to prevent de Quervain’s tenosynovitis?
Avoiding repetitive movements is the most important way to prevent de Quervain’s tenosynovitis. Change your actions to reduce the stress on your wrists, and take frequent breaks to rest. Wear a brace or splint on your thumb and wrist, if necessary.
Follow the exercise routine suggested by your doctor or physical therapist. Be sure to tell him or her about any activities that cause pain, numbness or swelling.

Tests and diagnosis:
To diagnose de Quervain's tenosynovitis, your doctor will examine your hand to see if you feel pain when pressure is applied on the thumb side of the wrist.

Your doctor will also perform a Finkelstein test, in which you bend your thumb across the palm of your hand and bend your fingers down over your thumb. Then you bend your wrist toward your little finger. If this causes pain on the thumb side of your wrist, you likely have de Quervain's tenosynovitis.

Imaging tests, such as X-rays, generally aren't needed to diagnose de Quervain's tenosynovitis.
Treatment for de Quervain's tenosynovitis is aimed at reducing inflammation, preserving movement in the thumb and preventing recurrence.

Treatments and drugs:
If you start treatment early, your symptoms should improve within four to six weeks. If your de Quervain's tenosynovitis starts during pregnancy, symptoms are likely to end around the end of either pregnancy or breast-feeding.
Medications

To reduce pain and swelling, your doctor may recommend using over-the-counter pain relievers, such as ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve).

Your doctor may also recommend injections of corticosteroid medications into the tendon sheath to reduce swelling. If treatment begins within the first six months of symptoms, most people recover completely after receiving corticosteroid injections, often after just one injection.
Therapy

Initial treatment of de Quervain's tenosynovitis may include:

- Immobilizing your thumb and wrist, keeping them straight with a splint or brace to help rest your tendons
- Avoiding repetitive thumb movements as much as possible
- Avoiding pinching with your thumb when moving your wrist from side to side
- Applying ice to the affected area

You may also see a physical or occupational therapist. These therapists may review how you use your wrist and give suggestions on how to make adjustments to relieve stress on your wrists. Your therapist can also teach you exercises for your wrist, hand and arm to strengthen your muscles, reduce pain and limit tendon irritation.
Surgery

If your case is more serious, your doctor may recommend outpatient surgery. Surgery involves a procedure in which your doctor inspects the sheath surrounding the involved tendon or tendons, and then opens the sheath to release the pressure so your tendons can glide freely.

Your doctor will talk to you about how to rest, strengthen and rehabilitate your body after surgery. A physical or occupational therapist may meet with you after surgery to teach you new strengthening exercises and help you adjust your daily routine to prevent future problems.

Lifestyle and home remedies:
If you don't need surgery, caring for your condition is much the same as preventing it:

- Avoid moving your wrists the same way repeatedly.
- Wear a brace or splint if suggested by your doctor.
- Follow through with recommended exercises.
- Note activity that causes pain, swelling or numbness in your thumb and wrist, try to avoid it, and share that information with your doctor.

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