Generally prompted by awkward hand positions or posture, de Quervain's tendonitis is a condition that results from irritation or swelling of the compartment or tunnel around the tendons along the thumb side of the wrist. As the lining around the tendons becomes inflamed, the tunnel through which the tendons pass becomes constricted. This constriction makes it increasingly difficult for the tendons to move as they should - causing pain and tenderness on the thumb side of the wrist when forming a fist, grasping or gripping.

Swelling is noticeable and may be accompanied by a cyst filled with fluid. Patients may also experience "snapping" when the thumb is moved and have difficulty pinching. If the nerve lying on top of the tendon sheath becomes irritated, patients may also experience numbness on the back of the thumb and index finger.

Risk Factors
de Quervain's tendonitis is commonly found in those required to use their hands in new and awkward positions for a period of time - such as a piano student, or a new mother feeding an infant a bottle or pushing a stroller.

Diagnosis and Treatment
In determining diagnosis, the patient is asked to make a fist with the fingers over the thumb. The wrist is then bent towards the little finger, while the level of discomfort and range of motion is assessed. Patients also report tenderness directly over the tendons on the thumb side of the wrist.

Patients suffering from de Quervain's tendonitis are asked to refrain from the activity that prompted the swelling. Anti-inflammatory medication may also be used to reduce swelling and relieve pain. When the condition is nonresponsive to conservative treatment, a surgical procedure called de Quervain's Release is performed to open the compartment, or sheath, and widen the constricted area for the irritated tendons.

Rehabilitation and strengthening exercises are established following surgery.

Often coinciding with carpal tunnel syndrome, (link to Other Upper Limb Conditions/Hand/Medical Conditions/Carpal Tunnel) wrist synovitis is the inflammation of the synovial membrane lining the joints in the wrist - placing compression of the median nerve as it travels through the carpal tunnel.

Causing pain and discomfort during wrist movement, this condition may also present as a Ganglion cyst.

Risk Factors
While wrist synovitis most often affects those suffering from Rheumatoid Arthritis, it has also been diagnosed in young patients involved in sports, which are demanding on the wrist joint such as gymnastics and tennis.

Diagnosis and Treatment
Following a thorough review of the patient's medical history, a physical examination and assessment of the type of pain experienced, magnetic resonance imaging (MRI) will help identify the areas of vulnerability and confirm wrist synovitis.

The severity of the condition and other health factors will determine the treatment. Wrist synovitis may be treated with glucocorticoid injections into the joint. When a wrist ganglion and severe degenerative conditions exist despite the use of antirheumatic drugs (DMARDs) and other conservative treatment, a Synovectomy may be indicated.

A Synovetomy is done to remove the inflamed joint tissue (synovium) responsible for the pain, irritation and swelling. It may be done arthroscopically or open surgery.

Physical therapy begins one to two weeks following a procedure and focuses on restoring range of motion.

Often appearing on the hands and wrist, Ganglion cysts are small sacs filled with clear, jellylike fluid, which grow out of a joint and rise from the connective tissues between bones and muscles. The cyst appears as a round bump visible from under the skin. The size of the bump may vary depending on the patient's level of daily activity. Though they are generally painless, increasing activity that causes an increase in their size could put pressure on nerves and cause pain.

Risk Factors
Though the exact cause of Ganglion cysts is unknown, they are thought to be a reaction to an injury that causes the tendon sheath covering the tendon, or the joint capsule protecting the joint, to form extra fluid and expand outward. Ganglion cysts more often affect women than men. They are also common among gymnast, who repeatedly place weight and stress on the non weight-bearing wrist joint.

Diagnosis and Treatment
A thorough review of the patient's history, a physical examination and assessment of any pain and discomfort will help determine diagnosis and the best treatment plan. An X-ray may be indicated in order to eliminate the possibility of arthritis or a bone tumor. And occasionally an MRI or ultrasound is used to find ganglion cysts hidden deeper beneath the skin.

Conservative treatment is first indicated for these types of conditions. This may include a period of observation, perhaps combined with period of immobilization with a wrist brace or splint, if there is pain or tenderness.

Significant pain that interferes with daily activities may require aspiration in order to remove the fluid. And if the cysts continue to grow, a Ganglion Excision will be indicated in order to remove the cysts, along with a portion of the affected joint capsule or tendon sheath. This will permit normal resumption of activities in two to six weeks.