It's the sharp, constant pain on the thumb side of your wrist that gets worse every time you lift, twist, or grip something. The pain from De Quervain's tenosynovitis can be very bad, whether it's from lifting your new baby over and over again (a condition known as "mommy's thumb"), doing your job, or even how you hold your phone. But the way to get better is often easy and doesn't involve a long, costly trip to see a surgeon. Direct Primary Care (DPC) practices can quickly, effectively, and affordably diagnose and treat this kind of problem.
De Quervain's tenosynovitis is a common overuse condition that happens when the sheath around the two main tendons that control your thumb's movement becomes inflamed and thickens. It is the second most common problem with an arm tendon that is "pinched" or too tight.
The Signs That Tell You:
Pain and sensitivity on the side of your wrist that is closest to your thumb.
When you make a fist, grab things, or turn your wrist, the pain gets worse.
Sometimes, when you move your thumb, you feel like it's "sticking" or "catching."
The Diagnosis: The Finkelstein Test A simple and very specific move in the doctor's office almost always confirms the diagnosis. Your doctor will tell you to put your thumb in your palm, make a fist around it, and then gently bend your wrist down toward your pinky finger. A positive test is when there is sharp pain over the tendons on the thumb side of the wrist.
The good news is that this painful condition responds very well to non-surgical, conservative treatment.
Direct Primary Care (DPC) is a membership-based model that lets patients talk to their doctor whenever they want. The DPC model's focus on access and in-office procedures is a huge help for a common musculoskeletal problem like De Quervain's. DPC is the best option for this condition for the following reasons:
A quick diagnosis and a "see and treat" method: This is where DPC's usefulness and efficiency really show.
Same-Day Access: You can get seen for your bad wrist pain right away, without having to wait weeks for an appointment.
A Solution in One Visit: During a single, relaxed visit, your DPC doctor can do a full exam, use the Finkelstein test to make a sure clinical diagnosis, and start the right treatment.
The Corticosteroid Injection: The Best Treatment in the Office: High-quality medical evidence shows that the best non-surgical treatment for De Quervain's is an injection of corticosteroids into the inflamed tendon sheath, often with splinting.
Immediate, Certain Care: Many DPC doctors are very good at doing this simple but very effective procedure in their own offices.
Staying Away from the Runaround: This lets you get the treatment with the best chance of working right away, so you don't have to wait a long time, deal with a lot of trouble, or pay a lot of money to see an orthopedic or sports medicine specialist just for a simple injection.
Thorough, hands-on conservative care: Your DPC doctor will also take care of the other important parts of your recovery.
Immobilization: They can give you or fit you for a thumb spica splint to keep the inflamed tendons from moving.
Education and Prevention: They have the time to give you detailed advice on how to change your activities and improve your posture to keep the problem from coming back after it has healed.
Case 1: Jessica, 35, is a new mom who gets "mommy's thumb" because she keeps lifting her baby in a certain way. She goes to see her DPC doctor, who finds out that she has De Quervain's in the office. The doctor gives her a corticosteroid shot and puts her in a splint during the same 30-minute visit. Her pain is much better after a week, and she didn't have to go to the ER or wait a long time for an orthopedic referral.
Case 2: Michael, 48, loves to garden but has pain in his wrist that won't go away. His DPC doctor says he has De Quervain's. They begin with a splint and some anti-inflammatory drugs. It was easy to schedule a follow-up visit two weeks later, and his pain is better but not gone. The doctor then gives the corticosteroid shot in the office. The DPC model makes this step-by-step, closely watched care easy and helps people get better.
Q: Do I need an MRI or an X-ray for this pain in my wrist? A: Almost certainly not. It's not your bones that are the problem; it's your tendons. A good medical history and physical exam, especially the Finkelstein test, are used to make the diagnosis. In most cases, imaging isn't needed.
Q: Does the corticosteroid shot hurt? A: The needle poke hurts for a short time, but the area is numbed first, and the injection itself is very quick. For most people, the deep relief it gives over the next few days and weeks is well worth the short pain.
Q: Why can my DPC doctor do this instead of sending me to a specialist? A: DPC doctors have a lot of training and are experts at treating common outpatient problems. Many are very good at doing common office procedures like injecting into joints and tendon sheaths. The DPC model frees them from the billing and referral problems of the old system, allowing them to use all of their skills to give their patients complete and easy care, which saves them time, money, and trouble.
DPC has a clear advantage for this very common injury because:
Giving "See and Treat" Care: Providing a quick diagnosis and the best treatment based on evidence (like a steroid injection) all in one easy visit.
Avoiding expensive and unnecessary referrals to specialists: Successfully treating this common condition in primary care, which is much easier and cheaper for you.
Providing care that is based on evidence and worth a lot: Focusing on the conservative treatments that have been shown to work best for this condition.
The pain from De Quervain's tenosynovitis can make it hard to do things you love, like holding your baby or working in your garden. You don't have to go through a long, expensive journey through the specialist system to feel better. Direct Primary Care is a faster, easier, and less expensive way to get better, with hands-on, expert care from the doctor who knows you best.
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