DeQuervain’s Disorder
Recently I was asked to write an article regarding a specific condition. Usually, my articles are written relative to current topics that I feel will be of interest to my readers. However, since this request was made, I have thought about the hundreds of patients I’ve treated over the years for this specific condition and therefore, I feel some review and perhaps some recommendations will be helpful to many of you who suffer from this disorder.
The condition of which I refer to is DeQuervain’s “disease.” I intentionally emphasized the disease portion of this condition because it is also referred to DeQuervain’s Syndrome and DeQuervain’s Disorder. I tend to like the “disorder” description because this is not a disease contracted due to a compromised immune system. This is a condition which comes on typically to over use.
DeQuervain’s (DUH-QAIR-VAZ) is a condition which affects the bottom portion of the thumb side of your wrist, hand and forearm. A tendon in the hand and forearm which causes the motion of your thumb away from your fingers becomes inflamed and swollen. This is typically due to overuse. I often times see this condition as a result of using a computer or mouse, or repetitive motions in assembly line production. The symptoms are excruciating pain in the bottom portion of your thumb side of your wrist and forearm.
Some other conditions that might either cause of aggravate the disorder include a wringing motion such as what you would perform when wringing wet clothing, hammering, skiing using ski poles, knitting, or lifting heavy objects from the refrigerator, like a gallon of milk or a heavy frying pan.
This condition is more common in women than men; however, it can occur at any age. The most common group of individuals to experience this disorder is between the ages of 30 and 50. Typically, there is severe pain when gripping, rotating or twisting your wrist. You may hear a crackling or creaking sound from the wrist and thumb area. The area affected is swollen, sore and tender to the touch. It is particularly uncomfortable when you move your thumb away from your wrist, spreading your thumb away from your fingers. Occasionally, you can feel numbness in the outside of the hand and around the thumb and index finger regions. Cysts may also form in the area of the tendon. Years ago this was called a “Bible” cyst, because the cure for it was to lay your hand on a hard surface and whack it with a Bible, thereby causing the cyst to rupture and the fluid to come out of the cyst. This is a pretty extreme way to treat this condition, and I certainly do not recommend it!
The diagnosis for this condition is relatively easy. A test can be performed which was developed by Dr. Finkelstein. Finkelstein’s test involves the gripping of your thumb inside your fingers, like making a fist around your thumb, and then bending your hand towards the pinky finger side. This stretches the tendon involved and will cause severe pain if this is the cause of your symptoms.
Other conditions that can mimic these symptoms include arthritic change in the thumb joint, where the thumb meets the wrist. This is one of the most common areas in your body to have arthritic change occur early on. Neuralgia can also mimic the symptoms of DeQuervain’s syndrome which can be extreme and can be due to various causes including diabetes.
Things you can do to assist in the treatment of this condition include trying to immobilize or at least restrict the motion of the thumb away from the hand. Often times this involves altering the way you perform your work duties or eliminating your work duties for a period of time, particularly those that require you to pull your thumb away from your hand. Using ice over the area for ten to fifteen minutes approximately three times per day is also helpful.
My experience has been in the past that the use of passive modalities including muscle stimulating therapy and ultrasound may be helpful in treating this condition. Manipulation of the wrist and hand will restore normal motion and mobility to these joints, thereby significantly speeding the recovery period. If you suspect that you may have this condition early diagnosis and appropriate treatment by your doctor is critical for early resolution of this disorder.
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