Pain in wrist: possible De Quervain tenosynovitis

Dear Ask The Doctor: Hello Doc. I am a 27 years old software engineer. My right wrist has got issues since last 7-8 years. It pains when I bend my right wrist inwards or outwards. Its not continuos pain but I am unable to push heavy things or grip heavy object. I can't handle stuff effectively with my hand due to this. For e.g. I can't clean a v messy table with my hand, my wrist wouldn't be able to apply the force needed. I wouldn't be able to apply my body weight on my wrist, it pains a lot if I try it. I consulted orthopedic doctors in past and got few Xrays also but there were no abnormalities. I did Rheumatoid Arthritis test too back then but that was also normal. I was avoiding heavy tasks with my right hand as advised by the doc and my wrist was ok for most of time since last 3-4 years. The issue has worsened since few months now and I again went to an orthopedic doc and got digital xray. Again, it came clear. I am clueless what to do now. Can it be related to nerves. Should I see a neurologist in that case? Pls advice.

Dear Monica: Most likely what you described correspond to a Tenosynovitis De Quervain which is a condition caused by inflammation of the tendons in the first dorsal compartment of the wrist. The tendons involved are abductor  and extensor of the thumb. Repetitive radial(inner) and ulnar (outer)deviation of the wrist, associated with flexion of the thumb, causes thickening of the tendon sheath and pain when the inflamed tendons cross the distal end of the radius bone of the wrist. Patients with occupations that involve repetitive gripping and grasping with the thumb(writing) or pastimes such as racquet sports, golf, or disc throwing are the most susceptible to develop this condition. Risk factors include female sex; age over 40 years, and black race. Conservative treatment for this condition includes rest, ice, stretching and strengthening exercises, non steroidal anti-inflammatory drugs (“motrin”, “aleve”), and immobilization of the thumb. If these measures fail, studies have proven the efficacy of local steroid injections in treating the condition. However, if symptoms recur or do not resolve after 2 injections, surgical consultation is indicated. Surgery involves decompressing the first dorsal compartment by making an incision through the tendon sheath.