De Quervain’s Tenosynovitis aka “Mummy Thumb” (Part 1)

De Quervain’s tenosynovitis or “mummy thumb” is a common hand condition that arises frequently with overuse of the thumb and wrist. It is a painful condition that involves the inflammation of two thumb tendons (the abductor pollicis longus and extensor pollicis brevis) at the side of the wrist and base of the thumb. Over time, this can also cause thickening of the tendon sheaths (soft tissue coverings encasing the tendons), which then traps the tendons. This makes it difficult for the tendons to glide through the sheaths during functional use and movements of the thumb.

How common is de Quervain’s tenosynovitis?

The prevalence of de Quervain’s tenosynovitis among adults of working age in the general population is about 0.5% in men and 1.3% in women, with it being diagnosed most frequently between the ages of 40 to 60 years old. Indeed, de Quervain’s have been found to be 4.5 times more likely to occur in women than men. It is also thought to occur more frequently in women during pregnancy and postpartum periods, hence its alternative name “mummy thumb”.

What causes de Quervain’s tenosynovitis?

It is often difficult to pinpoint the exact cause of de Quervain’s tenosynovitis, with some cases occurring after acute traumatic injuries (such as sustaining a blunt force impact over the wrist, forceful sideway movements of the thumb and wrist). Anatomical variations and abnormalities in the area where the two thumb tendons are located may also increase an individual’s risk of developing de Quervain’s tenosynovitis. Most cases, however, often occur from the accumulative effects of chronic overuse (i.e. repetitive movements/usage of the wrist and thumb), leading to increased frictional forces or microtrauma to the affected tendons and their sheaths. Some examples of activities which may lead to or aggravate de Quervain’s tenosynovitis symptoms include:

  • Activities that require repetitive wrist and thumb motion, such as mobile phone usage, golfing, playing the piano, fly fishing, carpentry, office workers (e.g. frequent usage of the thumb in writing, typing and using of stapler/hole punchers) and musicians (e.g. prolonged playing of musical instruments which may require the wrist and thumb to be in awkward positions).
  • Mothers of newborns who are repeatedly lifting a newborn or who are assuming breastfeeding postures that place the wrist and thumb in awkward positions.
  • Repetitive gripping, grasping, clenching, pinching, or wringing of objects (e.g. handwashing laundry, frequent wringing dry of rag cloths when cleaning furniture, prolonged scissor use when cutting objects).

What are the symptoms of de Quervain’s tenosynovitis?

The main symptom of de Quervain’s tenosynovitis is pain over the wrist, below the base of the thumb, which may radiate up along the forearm. This pain is usually aggravated with use of the affected hand and thumb in activities that require repetitive or forceful pinching and grasping, twisting of the wrist, and lifting of objects with the wrist/thumb positioned in awkward angles. Some examples include cutting objects with scissors, holding your mobile phone or tablet with your thumb and fingers for long periods of time, frequent texting on your mobile phone, pulling up pants, prolonged/frequent usage of tongs when serving food, and opening tight jar or bottle lids.

Swelling over the side of the wrist at the base of the thumb is also a common symptom, with some people reporting a “snapping” sensation over the wrist when moving/using the thumb. Muscles over the wrist and thumb can also become tighter with the ongoing inflammation, pain and swelling, leading to some restrictions in wrist and thumb movements.

Stay tuned for Part 2 of our discussion on de Quervain’s tenosynovitis, which will focus on assessment and treatment options for this condition.


Sources:

Allbrook, V. (November 2019). ‘The side of my wrist hurts’: De Quervain’s tenosynovitis. Australian Journal of General Practice, 48(11). Retrieved August 27, 2021, from https://www1.racgp.org.au/ajgp/2019/november/side-of-my-wrist-hurts

American Academy of Orthopaedic Surgeons. (2013). De Quervain’s Tendinosis. Retrieved August 27, 2021, from https://orthoinfo.aaos.org/en/diseases–conditions/de-quervains-tendinosis/

Physiopedia. (2021). De Quervain’s tenosynovitis. Retrieved August 27, 2021, from https://www.physio-pedia.com/De_Quervain%27s_Tenosynovitis

Wolf, J.M., Sturdivant, R.X., & Owens, B.D. (January, 2009). Incidence of de Quervain’s tenosynovitis in a young, active population. The Journal of Hand Surgery, 34(1), 112-115. Retrieved August 27, 2021, from https://sci-hub.do/https://doi.org/10.1016/j.jhsa.2008.08.020

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