De Quervain's tendinitis is a condition that results from irritation or swelling of the tendons along the thumb side of the wrist - generally prompted by awkward hand positions. The irritation causes the lining around the tendon to swell, changing the shape of the compartment and making it difficult for the tendons to move as they should.

Those suffering from the condition may experience pain on the thumb side of the wrist and tenderness when forming a fist, grasping and gripping and twisting the wrist. Swelling is noticeable and may be accompanied by a cyst filled with fluid. They may also experience a "snapping" when the thumb is moved and find pinching difficult.

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.

Those at Risk
This condition is commonly found in those required to use their hands in new and awkward positions for a period of time - such as a new mother feeding an infant a bottle or pushing a stroller, or someone learning to play the piano.

Diagnosis
A test is performed to confirm the presence of De Quervain's tendinitis. It requires the patient to make a fist with the fingers over the thumb. The wrist is then bent towards the little finger and the level of discomfort and difficult of movement is assessed. Patients also report tenderness directly over the tendons on the thumb side wrist.

Treatment
Treatment may consist of simply refraining from the activity that prompted the swelling, or involve the use of anti-inflammatory medication to reduce swelling and relieve pain. When the condition is non responsive to conservative treatment, surgery to open the compartment, or sheath, and widen the constricted area for the irritated tendons is performed.

Rehabilitation and strengthening exercises are established following surgery.

Wrist synovitis is the inflammation of the synovial membrane lining the joints in the wrist and often coincides with carpal tunnel syndrome at the wrist - with compression of the median nerve as it travels through the carpal tunnel.

It is often found in patients suffering from Rheumatoid Arthritis, and may also present itself in the form of a Ganglion cyst. Patients suffering from the condition suffer from pain and discomfort when moving the wrist.

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

Diagnosis
Patient history and the type of pain experienced will provide some insight for diagnosis. Magnetic resonance imaging (MRI) will help identify the areas of vulnerability and confirm wrist synovitis.

Treatment
Depending on the severity of the condition and other vulnerabilities that may exist, wrist synovitis may be treated with glucocorticoid injections into the joint. When wrist synovitis presents with a wrist ganglion and deteriorating conditions following the use of antirheumatic drugs (DMARDs) and other conservative treatment, a Synovectomy may be recommended.

A Synovectomy is done to remove the inflamed joint tissue (synovium) that is causing the pain, irritation and swelling. It may be done arthroscopically or surgically.

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

Ganglions are small sacs filled with clear, jellylike fluid often appearing on the hands and wrists, but can also develop on shoulders, feet and ankles as well. They grow out of a joint and rise from the connective tissues between bones and muscles to form a round bump visible from under the skin. The size of the bump will vary depending on the level of activity. Though they are generally painless, increasing activity that causes the ganglion to increase in size could put pressure on nerves and cause pain.

Those at Risk
While the cause of Ganglions is unknown, it is 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 balloon out. Women are more often affected by Ganglions than men. And they are common among gymnast, who repeatedly place weight and stress on the non weight-bearing wrist joint.

Diagnosis
While Ganglions are rarely painful a physical examination will help determine 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 ganglions hidden under the skin.

Treatment
With these types of conditions, the first treatment options considered are always conservative and non surgical. This may include a period of observation, perhaps combined with period of immobilization with a wrist brace or splint - in order to relieve any pain or tenderness.

If the ganglion causes significant pain or interferes with daily activities, aspiration may be considered in order to remove the fluid.

If the cysts continue to grow, outpatient surgery can remove it as well as a portion of the affected joint capsule or tendon sheath - with a normal resumption of activities in two to six weeks.