De Quervain's tenosynovitis and tendonosis are slightly different disorders that affect the tendon sheath or tendon at the base of the thumb. These conditions are frequently caused by repetitive use, such as writing or playing video games, but can also be caused by underlying inflammatory arthritis. There are different strategies that may be helpful for reducing or eliminating pain.
Bracing is the easiest conservative treatment since it helps immobilize the thumb and/or wrist. Depending on how you use your hands, there are two types of braces that may be helpful. The first type has a hole that allows free movement of the thumb, and the brace wraps around the wrist to constrict range of motion in the wrist. Other braces are similar, but they also restrict thumb movement. If you do not need significant use of your thumb and moving your thumb causes pain, the latter type of brace will be helpful. The former type of brace will give you more range of motion in all your fingers but may not be as effective at reducing pain.
If keeping the thumb and wrist immobilized does not provide adequate relief or you have no other option but to work without a brace, pain management may be necessary. Generally, your doctor will recommend using small doses of retail NSAIDs for the shortest duration possible. These medications are helpful because they reduce pain while decreasing the inflammatory processes that are responsible for the condition and underlying diseases that might cause tendon-related pain.
Depending on the extent of your pain and your need to use your thumb and wrist, a steroid injection might be more helpful. The steroid is injected in or near the tendon sheath. Once the tendon sheath is less inflamed, the tendon can typically glide freely within the sheath without rubbing or catching. If the actual tendon is inflamed, an injection in the area should also be helpful. There will be a temporary improvement in pain as the local anesthetic takes effect, but once this wears off, the pain will return until the steroid begins to work.
Severe pain and limitations or prolonged issues that are not adequately responding to conservative measures may require surgery. The goal of surgery is to create a larger opening for the tendons so they can glide unobstructed, which reduces pain and can prevent the repetitive cycle of inflammation. To accomplish the unobstructed gliding of the tendons, the sheath is cut to make additional room. Fortunately, the procedure can be done with outpatient surgery and may not require significant recovery time. After recovering from surgery, some people may need physical therapy if they experienced any nerve issues or weakness as a result of having chronic inflammation and immobilization.
De Quervain's tenosynovitis and tendonosis can be acute problems that are easily fixed with brief periods of rest and immobilization. In some instances, especially depending on your field work or if you have underlying inflammatory arthritis, more intensive treatment strategies might be necessary for long-term relief. For more information, contact an orthopedic physician in your area.