Radial Styloid Tenosynovitis
De Quervain’s Tendinosis
Radial styloid tenosynovitis, previously known as De Quervain’s tendinosis, occurs when the tendons around the base of the thumb are irritated or constricted. This swelling of the tendons and the tendon sheath can cause pain and tenderness along the thumb side of the wrist. This condition is particularly noticeable when forming a fist, grasping or gripping something, or when turning the wrist.
Two of the main tendons to the thumb pass through a tunnel (or series of pulleys) located on the thumb side of the wrist. Tendons are rope-like structures that attach muscle to bone. The synovium is a slippery thin soft-tissue layer that covers the tendons and allow them to easily slide through a fibrous tunnel called a sheath. Any swelling of the tendons and/or thickening of the sheath can cause increased friction and pain with certain thumb and wrist movements.
Radial styloid tenosynovitis may be caused by overuse. It also is associated with pregnancy and rheumatoid disease. It is most common in middle-aged women.
Signs of radial styloid tenosynovitis:
- The main symptom is pain that may be felt over the thumb side of the wrist. The pain may appear either gradually or suddenly and increases in severity with thumb usage or sudden twist in the wrist. Pain is often felt in the wrist and can travel up the forearm.
- Swelling may be seen over the thumb side of the wrist. This swelling may also accompany a fluid-filled cyst in this region.
- A “catching” or “snapping” sensation may be felt when moving the thumb.
- Pain and swelling may make it difficult to move the thumb and wrist.
To determine whether or not you have radial styloid tenosynovitis, your doctor may ask you to perform the Finkelstein test by placing your thumb against your hand, making a fist with your fingers closed over your thumb, and then bending your wrist toward your little finger. If you have tenosynovitis this test is quite painful as you will experience tendon pain on the thumb side of the wrist.
The goal in treating radial styloid tenosynovitis is to relieve the pain from irritation and swelling.
- Splints: splints may be used to rest the thumb and wrist.
- Anti-inflammatory medication (NSAIDs): These medications can be taken by mouth or injected into a tendon compartment. This may help reduce swelling and relieve pain.
- Avoiding activities that cause pain and swelling. This may allow the symptoms to go away on their own.
- Corticosteroids: Injection of corticosteroids into the tendon sheath may help reduce swelling and pain.
- Surgery may be recommended if symptoms are severe or do not improve with more conservative treatments. The goal of surgery is to open the thumb compartment to make more space for the irritated tendons.
Regardless of the treatment, normal use of the hand usually can be resumed once comfort and strength have returned. Your surgeon can advise you on the best treatment for your condition and recommend therapy as needed.
OrthoInfo. (2020). Diseases and conditions: De Quervain’s tendinosis. Retrieved from https://orthoinfo.aaos.org/en/diseases–conditions/de-quervains-tendinosis/