Houston Methodist. Leading Medicine

Hand FAQ

Question:

I can no longer touch the tip of my thumb to the base of my little finger due to pain and swelling. The swelling is along the top of the thumb and wrist. What could be causing this problem?

Answer:

The symptoms you described could be coming from a couple of different problems. The most likely is something called de Quervain's tenosynovitis. But you could also have arthritis of the joint at the base of the thumb, wrist arthritis, or another condition called intersection syndrome. De Quervain's tenosynovitis is described as a thickening of the tendon sheath, enlargement of the tendons, and thickening of tenosynovium. The tenosynovium is a slippery covering that allows the two tendons to glide easily back and forth as they move the thumb. Inflammation of the tenosynovium and tendon is called tenosynovitis. This condition affects two thumb tendons. These tendons are called the abductor pollicis longus (APL) and the extensor pollicis brevis (EPB). On their way to the thumb, the APL and EPB tendons travel side by side along the inside edge of the wrist. They pass through a tunnel near the end of the radius bone of the forearm. The tunnel helps hold the tendons in place, like the guide on a fishing pole. A quick and easy way to see if you have de Quervain's is to place your hand on the edge of a table (or arm rest on a chair) with the wrist supported but the hand off the edge of the supporting surface. Now tilt your hand down toward the floor. When someone else is examining you, that examiner will then gently grasp your hand and passively (without your help) move the wrist a little farther in the downward direction. You can use your other hand to do this to yourself. The final step is for the examiner to press down on your thumb (moving it toward your palm). Again, you can use your other hand to do this to your painful hand. Neither one of these last two steps is performed if you (or the patient) have pain with the first step. There are other tests that can sort out de Quervain's from arthritis. The best way to get an accurate diagnosis is to see your physician (either your primary care doctor or an orthopedic surgeon). Getting a diagnosis and treatment early on can help prevent this from becoming a chronic problem. Courtney Dawson, MD, and Chaitanya S. Mudgal, MD. Staged Description of the Finkelstein Test. In The Journal of Hand Surgery. September 2010. Vol. 35A. No. 9. Pp. 1513-1515.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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