What Is Ankylosing Spondylitis?

The condition centers on the sacroiliac joints, where the base of the spine meets the pelvis, and on the spine itself. Inflammation at those sites produces pain and stiffness. Over years, sustained inflammation can lay down new bone, and in some people segments of the spine gradually fuse, which reduces movement.

Two things to know first. Not everyone with this condition goes on to significant fusion, and outcomes have changed considerably with modern treatment. And the inflammation can reach beyond the spine, which is why a rheumatologist asks about your eyes, bowel and skin at appointments that seem to be about your back.

✅ MERGED (Kim, 2026-08-03): one condition, one guide. This guide is the single owner for both names. Ankylosing spondylitis and axial spondyloarthritis are treated as one subject; the copy names both terms, the acquired axial-spondyloarthritis page is NOT rewritten separately, and its URL 301s here. Cannibalization rules the call; the naming nuance stays as an ordinary for eventual clinical review, never a publication blocker.

Symptoms of Ankylosing Spondylitis

• Back and buttock pain and stiffness, worst in the morning or after staying still, and better with movement and exercise.
• Pain in the second half of the night that can wake you and improve once you get up.
• Stiffness lasting well past waking, rather than the few minutes an ordinary stiff back takes.
• Pain in the hips, neck, or the joints where the ribs meet the spine, which can make a deep breath uncomfortable.
• Fatigue, which tracks with inflammation and is often underestimated.
• Tendon pain at the heel or the sole of the foot.
• Less commonly, appetite loss, weight change or bowel symptoms.

Sustained inflammation also weakens bone over time, raising the risk of spinal fractures, and it can involve the heart and the aorta in a few people. Both are reasons for monitoring.

When to Get Help Now

Call 911 or go to the emergency department for:

• Chest pain or pressure, or trouble breathing.
• A fall followed by new neck or back pain, even after a minor fall, because a stiffened spine with lower bone strength can break unstably.
• New weakness or numbness in the legs, or any change in bladder or bowel control, which can mean pressure on the spinal cord.
• A joint that is hot, swollen and very painful along with a fever.
• Sudden loss of vision in one or both eyes.

Call your care team the same day for:

• A painful, red eye with light sensitivity or blurred vision. Inflammation inside the eye is treatable and can affect vision if it is left, so here it is urgent.
• A fever with no obvious cause, and sooner for anyone taking a medicine that suppresses the immune system.

When you cannot tell which list you are in, call and describe what is happening; if nobody can be reached and it looks like the first list, go.

Causes of Ankylosing Spondylitis

The underlying cause is unknown. What is understood is that genetics matter a great deal. The HLA-B27 gene is present in most people with ankylosing spondylitis, and most people who carry it never develop the condition. It raises risk without determining anything.

Risk Factors for Ankylosing Spondylitis

• Family history, which reflects that genetic contribution.
• Age at onset. Symptoms usually begin in adolescence or early adulthood, which is younger than most people expect for arthritis and part of why it goes unrecognized.
• Related conditions. Crohn's disease, ulcerative colitis, and psoriasis are associated with a higher risk.

Diagnosis of Ankylosing Spondylitis

Diagnosis is often delayed, sometimes by years, because inflammatory back pain in a young adult is easy to blame on sport, work, or an old injury.

There is no single confirming test. A rheumatologist assembles the picture from your history, an examination of spinal movement and the sacroiliac joints, blood tests that look for inflammation, and HLA-B27 testing, which supports the picture without settling it. Imaging is central: X-rays can show established changes at the sacroiliac joints, and MRI can show active inflammation earlier, before changes appear on an X-ray.

The pattern of your pain is a large part of the evidence, so arrive able to describe it: when it is worst, what it does overnight, how long the morning stiffness lasts, and what movement does to it.

[Gap-fill note: this section is substantially net-new. The FMC source covered diagnosis in two sentences. SME review required before publication.]

Treatment Options for Ankylosing Spondylitis

Treatment aims to control inflammation, keep the spine mobile, and protect long-term function.

Exercise and Therapy

Exercise is treatment rather than advice. Regular movement, stretching, and posture work are the foundation of care, and count for more here than in most forms of arthritis. Physical therapy with a therapist who can build a program to your own pattern helps with sleeping and working positions too.

Medicines

Nonsteroidal anti-inflammatory medicines are usually the first medicines used and help a great deal in many people. Biologic medicines target specific parts of the inflammatory process and are used where inflammation is not controlled by the steps above; some are given by infusion, and they have changed what this condition looks like over a lifetime. Corticosteroids are used in a targeted way, including by injection into a sacroiliac joint or a tendon attachment, rather than as long-term treatment for the spine.

Surgery

A minority of people need surgery, for a severely damaged hip joint or a spine that has fused in a position affecting daily life.

Smoking accelerates the course of this condition and works against every treatment, so stopping is one of the most useful things available. Bone health, including calcium and vitamin D and a bone density scan where it is needed, is part of the plan as well.

Living With Ankylosing Spondylitis

Move every day. The stiffness responds to movement, and consistency beats intensity. A short morning routine makes the first hours workable.

Break up the places you stay still. Long stretches at a desk or in a car are where stiffness builds, and interrupting them is worth more than a perfect chair.

Sleep flat rather than curled where you can. A firmer mattress and a thinner pillow suit most people better.

Tell any new clinician you have it, including in an emergency after any fall. A fused or stiffened spine changes how injuries behave and are handled.

Keep the eye symptom in mind. A painful red eye is a same-day call.

Expect the fatigue to be real, and treat pacing as part of managing the condition.

If the people around you want to understand any of this, our guide for partners and family walks them through it. Send it to whoever keeps telling you to rest; it explains why exercise is part of the treatment.

[Gap-fill note: this section is entirely net-new. The FMC source carried no living-with guidance. SME review required before publication.]

When to Talk to Your Care Team

Reach out if pain or stiffness is climbing, if a medicine has stopped working as it did, if you develop eye pain or redness, if you have new bowel or skin symptoms, or if you have had a fall. Your team expects to hear about symptoms outside the spine, since they often change the plan.

If you are still without a diagnosis and what you have read here matches your pattern, ask directly about a rheumatology referral. The pattern of the pain is the thing to bring.

What Are Autoimmune Diseases?

More than eighty autoimmune conditions have been identified, and they affect almost every part of the body. Despite that variety, they share features, and recognizing them often leads someone to a rheumatologist. They are not contagious, and you cannot pass one to anyone.

The Conditions We Treat

Each has its own guide.

Inflammatory arthritis Rheumatoid arthritis · Psoriatic arthritis · Ankylosing spondylitis

Connective tissue disease Lupus · Scleroderma · Sjögren's syndrome, in which the immune system attacks the glands that make tears and saliva · Myositis, in which it attacks muscle, causing weakness in the hips, thighs, shoulders and neck

Related conditions our teams see Vasculitis, inflammation of the blood vessels themselves · Mixed connective tissue disease, which carries overlapping features of several conditions at once · Antiphospholipid syndrome, which raises the risk of blood clots and matters particularly in pregnancy

Autoimmune conditions cared for elsewhere in Orlando Health, because they affect a different system: multiple sclerosis (neurology) · type 1 diabetes (endocrinology) · psoriasis affecting the skin (dermatology) · inflammatory bowel disease (digestive health). Your rheumatologist coordinates with those teams when a condition involves more than one.

Symptoms of Autoimmune Diseases

What you feel depends on the condition, and some things recur across the family:

• Early symptoms are ordinary ones: fatigue, aching joints, low-grade fevers, rashes.
• They flare and settle. Symptoms rise for a period, then settle, sometimes for a long time. A settled stretch does not mean the condition has gone.
• Severity varies enormously between two people with the same diagnosis.
• Many involve fatigue that rest does not fix, which is real disease activity rather than tiredness.
• They frequently involve more than one body system, which is why a rheumatologist asks about your eyes, your skin, your bowel and your breathing at an appointment that seemed to be about your joints.

When to Get Help Now

Call 911 or go to the emergency department for:

• Chest pain or pressure, or trouble breathing.
• Face drooping, weakness on one side, trouble speaking, or a sudden severe headache unlike any before.
• Sudden loss of vision in one or both eyes.
• A joint that is hot, swollen and very painful along with a fever. A joint infection can look like a flare.
• Coughing up blood.

Call your care team the same day for:

• A flare that is not easing.
• A fever, if you take medicine that lowers the immune system.
• A new rash, new numbness, or a symptom in a part of the body that has not been involved before.

When you cannot tell which list you are in, call and describe what is happening; if nobody can be reached and it looks like the first list, go.

Causes of Autoimmune Diseases

What causes the immune system to turn is not established. Genetics contribute, and so do factors in the environment, and research is active. Nothing you did caused this.

Risk Factors for Autoimmune Diseases

• A family history. These conditions tend to run in families, though what runs in a family is often a tendency toward autoimmunity generally rather than one specific disease.
• Being a woman. They are diagnosed more often in women, and several of them considerably more often.

Diagnosis of Autoimmune Diseases

These diseases are hard to diagnose for three reasons that compound each other. The early symptoms are ordinary ones, and each looks like something common and less serious. They come and go, so an appointment often lands during a settled stretch when the rash has faded and the joints have settled. And they cross specialties, so a person gets referred to whoever matches their most obvious symptom, and each specialist examines their own territory carefully and finds a picture that does not quite explain everything.

There is also no single test. Antibody blood tests, such as the antinuclear antibody test, are part of the picture and they do not settle it: a positive result appears in plenty of people who never develop an autoimmune disease, and a normal result does not rule one out. Diagnosis is a judgment built from your history, an examination, several tests read together, and often the pattern over time. See how we tell autoimmune diseases apart.

If you have been told your labs are normal and your symptoms have continued, that is a reason to keep going rather than to stop. Rheumatology is the specialty that looks across all the body systems at once, which is why these workups tend to end up there.

What a Specialist Visit Involves

A first rheumatology appointment is mostly a conversation, and a long one on purpose. Your rheumatologist will want the whole history, including the parts other clinicians set aside, because the pattern over time is often where the diagnosis lives. They will examine your joints and look for signs elsewhere (skin, eyes, mouth), review earlier testing, and order what is missing.

If a diagnosis is not clear at the end, a good rheumatologist will say so plainly and tell you what would make it clearer, which sometimes means seeing how things develop over a few months. That is how a condition that reveals itself over time gets diagnosed accurately.

If You Do Not Have a Diagnosis Yet

Many people arrive here without a name for what is happening, often after years. Keep a dated record of symptoms, when they started and how long they lasted: your own timeline is evidence. Photograph anything visible, since a rash on the day it appeared is worth more than a description of it weeks later. Bring your results together, because tests spread across several offices tell a story none of them holds alone. And ask about a rheumatology referral if your symptoms involve more than one body system and nobody has made one.

Being taken seriously is the baseline, not something you have to earn. If you have been told more than once that this is stress, that is a reason to seek another opinion, and second opinions are welcome here.

Treatment Options for Autoimmune Diseases

Treatment depends on which condition you have, and each guide sets out its own. At family level the aim is the same: to calm the immune response, ease symptoms, and protect the organs and joints involved.

Medicines

Medicines that lower or redirect the immune response are the core of treatment for many of these conditions. They include corticosteroids, immunosuppressive medicines, biologic medicines and, for some conditions, antimalarial medicines, and some are given by infusion. Which one suits you depends on the condition, how active it is, and your other health.

Therapy and Rehabilitation

Physical therapy and a plan for movement, sleep and fatigue go alongside medicine for many people. The plan is individual and made with your care team, and your rheumatologist coordinates with the other teams when a condition involves more than one system.

Living With an Autoimmune Disease

These are long-term conditions, and most people find a rhythm of flares and stable stretches over time. Keep a record of what a flare feels like for you, so a change is easy to point to. Plan around fatigue as part of the disease rather than a personal failing. Keep your appointments through the stable stretches, when the plan can be adjusted calmly.

When to Talk to Your Care Team

Call if you have symptoms that involve more than one body system, if you have been told your labs are normal and your symptoms have continued, or if a diagnosis you were given no longer explains what is happening. If you already have a diagnosis, call before a flare is a crisis, and before you stop a medicine on your own.

What Is Carpal Tunnel Syndrome?

The median nerve carries sensation from your thumb, index finger, middle finger, and half of your ring finger, and it supplies some of the muscles at the base of the thumb. When it is compressed at the wrist, those are the areas that lose sensation and, over time, strength.

Caught early, carpal tunnel syndrome usually responds well to treatment that does not involve surgery. Left for a long time, nerve compression can produce muscle loss at the base of the thumb that does not fully recover, which is the main reason we prefer to see this sooner.

Symptoms of Carpal Tunnel Syndrome

Carpal tunnel syndrome follows a recognizable pattern, and the pattern is often what distinguishes it from other causes of hand pain:

• Numbness and tingling in the thumb, index, middle, and half the ring finger. The little finger is usually spared, which is a useful clue.
• Symptoms that are worse at night and that wake you, often relieved by shaking or hanging the hand.
• Pain in the wrist and hand, sometimes travelling up the forearm.
• Weakness and dropped objects, particularly a pinch grip that gives way.
• Clumsiness with small tasks, buttons, coins, keys.

The night-time pattern is the most characteristic feature, so we answer it separately in Why Is Carpal Tunnel Worse at Night?

Constant numbness that no longer comes and goes, or visible thinning of the muscle at the base of the thumb, means the nerve has been under pressure for a long time. Both are reasons to be seen promptly rather than to keep waiting.

When to Get Help Now

Call 911 or go to the emergency department for:

• A hand or fingers that turn pale, blue or cold after an injury, or an injury after which you cannot use the hand.
• A hot, red, swollen hand along with a fever.
• Sudden numbness or weakness in the hand together with face drooping, weakness on one side of the body, or trouble speaking, which can be a stroke.
• Numbness or tingling that began suddenly after a wrist fracture or dislocation, which may need urgent surgery.

Call your care team the same day for:

• Numbness that has become constant rather than coming and going.
• Visible thinning of the muscle at the base of the thumb.
• Dropping things, or a pinch grip that is giving way quickly.

When you cannot tell which list you are in, call and describe what is happening; if nobody can be reached and it looks like the first list, go.

Causes of Carpal Tunnel Syndrome

The carpal tunnel is a narrow passage bounded by bone on three sides and a stiff band of tissue across the front. Anything that raises the pressure inside it or reduces the room available presses on the nerve. It shows up in a few different patterns:

• Without an identifiable cause, which is the most common. Repetitive or sustained wrist positions often contribute.
• Alongside another condition that produces swelling or inflammation, including rheumatoid arthritis, diabetes, and thyroid conditions.
• Suddenly, after a wrist injury such as a fracture or dislocation, which compresses the nerve quickly.

Risk Factors for Carpal Tunnel Syndrome

• Sustained or repetitive wrist positions, particularly with the wrist bent, and work or hobbies that involve vibration or forceful gripping.
• Conditions that cause inflammation or fluid retention, including rheumatoid arthritis, diabetes, and an underactive thyroid.
• Pregnancy, where fluid retention can produce symptoms that often settle after delivery.
• Anatomy. Some people simply have a narrower carpal tunnel, which appears to run in families.
• A previous wrist fracture or dislocation, which can change the shape of the passage.

Treating a contributing condition often improves the hand.

Diagnosis of Carpal Tunnel Syndrome

Diagnosis starts with your history: which fingers, what time of day, what makes it better, how long it has been going on.

The examination includes tests that briefly provoke the nerve, by tapping over it at the wrist or holding the wrist bent, to see whether your symptoms reproduce. Sensation and grip strength are checked, along with the muscle at the base of the thumb.

Where the picture needs confirming, or where the severity matters to the plan, nerve conduction studies and electromyography measure how well the nerve is carrying signals across the wrist. Ultrasound or MRI is used less often, mainly to look for another cause. These tests also help tell carpal tunnel syndrome from nerve compression higher up in the arm or neck.

Treatment Options for Carpal Tunnel Syndrome

Treatment usually works through the conservative options first, and most people improve there.

Splints and Changes to What Provokes It

A wrist splint, worn at night to hold the wrist straight, is often the single most effective first step, because the sleeping wrist position is a large part of what drives night symptoms. Changing what provokes the symptoms helps too, including workstation setup, tool choice, and taking breaks from sustained gripping or bent-wrist positions.

Therapy

Hand therapy works on nerve and tendon mobility and on how you use the hand; physical therapy describes how a therapist works.

Injections

A corticosteroid injection into the carpal tunnel reduces inflammation and can relieve symptoms for a period.

Surgery

Carpal tunnel release surgery divides the band across the front of the tunnel to take the pressure off the nerve. It is a short procedure and is generally considered when conservative treatment has not held, or when nerve testing and examination show the compression is advanced.

Which path suits you depends on how long you have had symptoms, how severe the nerve findings are, and what your hand does each day. We answer the decision people arrive with in Do I Need Surgery for Carpal Tunnel Syndrome?

Living With Carpal Tunnel Syndrome

Wear the splint at night if you have one. People often stop once symptoms ease, and symptoms then return. It is doing its work while you sleep.

Set up what you use most. Keep your wrists near neutral at a keyboard, a steering wheel, or a tool, and break up long uninterrupted stretches.

Treat the conditions underneath it. Where diabetes, thyroid, or inflammatory arthritis is contributing, managing that condition helps the hand.

Watch what happens overnight and over weeks. Symptoms that stay constant, or a grip that keeps weakening, are the changes that shift the plan.

Let the people you live with in on it. Our guide for families, Supporting Someone With Carpal Tunnel Syndrome, covers the nights, the splint habit and the first weeks after a release. Send it to whoever hears you shaking your hand out at 2 a.m.

When to Talk to Your Care Team

Come in if a splint and changes at work have not helped after several weeks, since there are other steps available before surgery is the question.

Your care team can also sort out whether the wrist is the whole story, since the neck and elbow can produce similar symptoms.

What Is Cubital Tunnel Syndrome?

The ulnar nerve brings sensation to the little finger and half of the ring finger, and it supplies most of the small muscles that spread your fingers, pinch and hold a strong grip. Squeezed at the elbow, it stops passing those signals cleanly, so the numbness and the weakness both trace back to one place.

The elbow is by far the most common place this nerve gets pinched, and pressure there is what cubital tunnel syndrome means. The same nerve can also be squeezed at the wrist or where it leaves the neck, and those are treated differently.

Symptoms usually build slowly and come and go for months before anyone looks at the elbow. Caught then, this responds well to treatment without surgery. Pressure left on the nerve for years can cost strength that does not fully return, which is why we would rather see it early.

Symptoms of Cubital Tunnel Syndrome

The pattern is recognizable:

• Numbness and tingling in the ring and little finger, worst when the elbow is bent: on the phone, driving, asleep.
• An ache on the inside of the elbow, sometimes into the forearm.
• Weakness in the hand. Grip that gives out, a pinch that will not hold a key, dropped objects, handwriting that has changed.

The fingers usually tell the two hand-nerve problems apart: this affects the ring and little finger, while carpal tunnel syndrome affects the thumb, index and middle finger, from a different nerve at the wrist. Some people have both.

Numbness that has stopped coming and going, a grip that keeps getting weaker, or hollows appearing between the bones on the back of your hand, are signs the nerve has been under pressure for a long time.

When to Get Help Now

Call 911 or go to the emergency department for:

• A hot, red, swollen elbow or hand along with a fever.
• An injury after which you cannot use the arm, or a hand that turns pale, blue or cold.
• Sudden numbness or weakness in the arm or hand together with face drooping, weakness on one side of the body, or trouble speaking, which can be a stroke.

Call your care team the same day for:

• Numbness in the ring and little finger that has stopped coming and going.
• A grip that keeps getting weaker, or hollows appearing between the bones on the back of your hand.
• Symptoms that began suddenly after a fall or a blow to the elbow.

When you cannot tell which list you are in, call and describe what is happening; if nobody can be reached and it looks like the first list, go.

Causes of Cubital Tunnel Syndrome

Pressure comes from two directions: something pressing on the nerve from outside, and the elbow held bent.

• Leaning on your elbow. A desk edge, a car door, an armrest. With no padding over the nerve, resting on it for long stretches presses it against bone.
• Holding or repeating a bent elbow. Driving, a phone held to your ear, sleeping curled up, and work or hobbies built on the motion, such as hand tools, carpentry, an instrument or throwing sports.
• Arthritis or bone spurs at the elbow joint, which take up room the nerve needs.
• A nerve that slides out of its groove as the elbow bends, which some people are simply built for.

Risk Factors for Cubital Tunnel Syndrome

• A previous elbow injury. A fracture or dislocation can change the shape of the groove, and scar tissue can crowd the nerve.
• Swelling inside the joint from an inflammatory condition. Inflammatory arthritis, including rheumatoid arthritis, can crowd the tunnel, and there the arthritis gets treated alongside the nerve.
• Conditions that leave nerves more vulnerable to compression, including diabetes.

Most people have more than one of these at once.

Diagnosis of Cubital Tunnel Syndrome

Diagnosis starts with your history: which fingers, what positions bring it on, how long it has been going on, and whether the elbow has ever been broken.

The examination checks sensation in each finger, grip and pinch strength, and the small muscles of the hand. Your care team may tap gently over the nerve behind the elbow to see whether that brings on the tingling, which is Tinel's sign, and may ask you to hold the elbow fully bent for a minute, which is the elbow flexion test. They will also feel whether the nerve stays in its groove as the elbow moves.

Where the picture needs confirming, or where severity matters to the plan, nerve conduction studies and electromyography are the next step: the first measures how fast and how strongly the nerve carries a signal past the elbow, and the second records how the muscles it supplies respond. An X-ray or MRI is used less often, mainly to look at the joint for a spur or an old injury, and ultrasound can show the nerve itself. These tests also separate the elbow from the neck and the wrist.

Treatment Options for Cubital Tunnel Syndrome

Treatment starts with taking the pressure off, and most people improve there.

Protecting the Nerve

Changing what presses on the nerve is the most effective first step for most people: the elbow off hard edges, a padded armrest, a headset instead of a phone held to the ear, a change to how a workstation or tool is set up. An elbow pad or a night splint keeps the elbow from folding tight while you sleep.

Therapy

Hand or occupational therapy works on how the nerve glides through the tunnel, on hand strength, and on the positions that keep provoking it; physical therapy describes how a therapist works. Where inflammatory arthritis, diabetes or a joint problem is adding to the pressure, treating that condition is part of the plan.

Surgery

Cubital tunnel release surgery divides the band of tissue over the tunnel so the nerve has more room. Your care team may recommend it when position changes and therapy have not held, or when nerve testing shows the compression is advanced. Ulnar nerve transposition gives the nerve a new path on the front side of the elbow, out of the groove behind the bump,.

Which path fits you depends on how long symptoms have been going on, what the nerve testing shows, whether the nerve stays in its groove, and what your hand does in your work and life.

Living With Cubital Tunnel Syndrome

Get the elbow off the edge. Desk, car door, armrest, arm of a chair. It is the hardest habit to notice.

Sleep with the arm out straight. A splint does this, and so does a loosely wrapped towel.

Keep up the stretching and strengthening your therapist gives you.

Bring the people around you in on the positions. Our guide for families, Supporting Someone With Cubital Tunnel Syndrome, covers the elbow habits, the nights and what a recovery asks for.

When to Talk to Your Care Team

Come in if a pad, a night splint and changes at work have not helped after several weeks, since there are more steps available before surgery is the question.

Your care team can also work out whether the elbow explains all of it, since the neck and the wrist can produce similar symptoms.

What Is De Quervain's Tenosynovitis?

Tenosynovitis means irritation of a tendon and of the sheath wrapped around it. Here the tendons are the two that control the thumb, called the abductor pollicis longus and the extensor pollicis brevis, and their shared tunnel lies right where most people point when asked where it hurts.

Caught early, this responds well to treatment that does not involve surgery. Left for a long time, the sheath can thicken enough that the tendons keep binding after the activity stops.

Trigger finger is the other common tendon-sheath problem in the hand, and some people have both.

Symptoms of De Quervain's Tenosynovitis

The usual picture:

• Pain on the thumb side of the wrist, sometimes running up into the forearm.
• Pain with gripping, pinching and twisting. Turning a key, opening a jar, lifting a child.
• Swelling and tenderness at the base of the thumb, occasionally with a firm fullness you can feel over the tendons.
• A catch or a creak as the thumb moves through its arc.

When to Get Help Now

Call 911 or go to the emergency department for:

• A hot, red, swollen wrist along with a fever.
• Wrist pain after a fall or a direct blow, after which you cannot use the hand.
• Sudden numbness or weakness in the arm or hand together with face drooping, weakness on one side of the body, or trouble speaking, which can be a stroke.

Call your care team the same day for:

• Marked redness and warmth over the wrist, which can point to an infection instead of an irritated tendon.
• Pain that is escalating quickly.
• Wrist pain that started suddenly after a fall or a direct blow, which raises the question of a fracture.

When you cannot tell which list you are in, call and describe what is happening; if nobody can be reached and it looks like the first list, go.

Causes of De Quervain's Tenosynovitis

Most of the time it follows weeks or months of a new repeated thumb motion: a new baby, a new job, a new hobby, a new phone or game controller. The everyday nicknames for it, mother's wrist and gamer's thumb, come from that pattern. Several things narrow the room the thumb tendons have, or add swelling inside it:

• Repeated thumb motion combined with a bent or twisting wrist. Typing, texting, gaming, knitting, hairdressing and work that involves gripping and turning put the thumb through the same arc thousands of times.
• Lifting a baby. The usual lift, thumbs spread wide and wrists bent back, is repeated dozens of times a day.
• Forceful, sustained gripping and vibration at work, which keep the tendons loaded between uses instead of letting them recover.

Risk Factors for De Quervain's Tenosynovitis

• Pregnancy and the months after delivery, and the menopausal transition, where fluid retention leaves less room inside the sheath. Symptoms that begin in pregnancy often resolve after delivery.
• Inflammatory arthritis. Rheumatoid arthritis can inflame the lining of tendon sheaths, and gout occasionally does, and either can be the reason a tendon problem will not resolve. If you have inflammatory joint pain elsewhere as well, our guide to Rheumatoid Arthritis covers that picture.
• Diabetes, which affects tendons and their sheaths throughout the hand and raises the likelihood of more than one hand condition at a time.

Treating a contributing condition often improves the wrist.

Diagnosis of De Quervain's Tenosynovitis

Diagnosis rests mainly on your history and the examination: when it began, what your hands were doing in the weeks before, and which motions reproduce it.

The examination presses along the tendons at the thumb side of the wrist to find the tender point, then moves the thumb and wrist to see which positions reproduce your pain. One of those movements is the Finkelstein test: you tuck your thumb into your fist and bend the wrist toward the little finger, which pulls the two tendons through their tunnel. Sharp pain in that spot supports the diagnosis.

Imaging is often not needed. An X-ray or an ultrasound is used mostly to rule out something else, including arthritis at the base of the thumb, which lies close by and can feel similar, or a small fracture after an injury.

Treatment Options for De Quervain's Tenosynovitis

Treatment starts with the options that ask least of you, and most people improve there.

Changing the Motion and Splinting

Finding the two or three motions that hurt every time and doing those differently does more than resting the whole hand. A thumb spica splint holds the thumb and the wrist still so the swelling inside the sheath can go down, through the day at first or only at night, depending on when your symptoms are worst.

Therapy

Hand therapy works on how the tendons glide, on strength around the wrist and thumb, and on the tasks that set your hand off; physical therapy describes how a therapist works.

Medicines

An anti-inflammatory medicine may help, where one is safe for you alongside anything else you take.

Injections

A corticosteroid injection into the tendon sheath reduces the swelling inside the tunnel so the tendons glide again. A clear response also supports the diagnosis.

Surgery

Surgery to release the sheath opens the tunnel over the two tendons through a small incision at the thumb side of the wrist, so the tendons are no longer squeezed. It is a short procedure, generally considered when splinting, activity change and an injection have not held.

Which of these suits you depends on how long you have had symptoms, what your hands need to do, and whether an inflammatory condition or diabetes is part of the picture.

Living With De Quervain's Tenosynovitis

Wear the splint the way it was fitted. People often stop as soon as the pain eases, and the pain then comes back.

Set up whatever you hold most. A phone, a controller, a mouse, a knife. Keep the wrist close to straight, and take short pauses, because an hour of uninterrupted thumb work costs more than the day's total does.

Build strength back gradually. Going straight back to full load is the usual reason symptoms return.

Treat what is underneath. Where rheumatoid arthritis, gout or diabetes is contributing, managing that condition helps the wrist as well.

Get the household onto the same plan. Our guide for families, Supporting Someone With De Quervain's Tenosynovitis, walks a partner through the lifts to take on and the weeks it runs for. Forward it before you have to ask twice.

When to Talk to Your Care Team

Come in if the pain has stopped improving with rest and a splint after a few weeks, if it wakes you at night, if you are avoiding tasks you need to do, or if your grip is giving out on things you used to hold without thinking. Any of those means there are further steps available, and most come well before surgery is the question.

Your care team can also work out whether the thumb tendons are the only thing going on.

What Is Dupuytren's Contracture?

The change is in the fascia, so the tendons, joints and nerves of the finger are not themselves diseased. The finger will not straighten because something outside it is holding it in, which is why stretching alone does not undo a cord.

It moves in stages, over years rather than weeks. A nodule appears first, often near the base of the ring finger. In some people a cord then forms and gradually tightens, and the finger follows it. Many people stop at the first stage.

The ring and little finger are affected most often. The middle finger, index finger and thumb can be involved too, and both hands often are, usually one more.

Symptoms of Dupuytren's Contracture

The first signs are usually small enough to ignore for a while:

• A firm lump in the palm, tender in some people and painless in most, often first noticed while holding something round.
• A cord you can feel under the skin, running from the palm toward the base of a finger and standing out as you open the hand.
• A finger that will not open all the way, usually the ring or little finger.
• The tasks that go first. A hand into a pocket or a glove, washing your face, a flat handshake.

Lost finger movement, more than pain, is what brings people in. A finger that catches and then snaps straight is a different problem, trigger finger; in Dupuytren's the finger is drawn in slowly and will not fully straighten at all.

When to Get Help Now

Call 911 or go to the emergency department for:

• A hot, red, swollen hand along with a fever.
• An injury after which you cannot use the hand.
• A fingertip that turns pale or blue, or feels cold, after a procedure.

Call your care team the same day for:

• A lump in the palm that has become painful, or that is growing or changing over weeks rather than years.
• New numbness in a finger after a procedure.
• After a procedure: drainage from the wound, spreading redness, or a fever.

When you cannot tell which list you are in, call and describe what is happening; if nobody can be reached and it looks like the first list, go.

Causes of Dupuytren's Contracture

What starts the tissue changing is not known. Ordinary hand use, gripping and manual work have not been shown to bring it on, though years of using vibrating tools may add to the risk.

Risk Factors for Dupuytren's Contracture

• Family history. The strongest and best established of the associations. It runs in families, and it appears more often in people whose families come from Northern Europe. Ancestry does not decide whether any one person develops it. If a parent or sibling has had it, tell your care team.
• Age. It most often appears after about 50, though it can start earlier.
• Sex. It is seen more often in men.
• Diabetes. People with diabetes develop it more often.
• Seizure conditions. An association with epilepsy is long described.
• Alcohol and smoking. Both appear in research, though the links are less settled than the family one.
• An injury or an operation on the hand, which sometimes comes just before the tissue starts to change.

Diagnosis of Dupuytren's Contracture

An examination of your hand is usually all this takes. Your care team feels for nodules and cords and checks how far each finger straightens and bends. Comparing those measurements at each visit is how the pace gets tracked.

You can check at home with the tabletop test: lay your palm flat on a table and see whether the whole hand, fingers included, rests flat. A finger that stays lifted is the sign to bring in.

An X-ray or ultrasound is ordered occasionally, mainly to look at another possible cause of a lump in the hand. No blood test diagnoses this condition.

Treatment Options for Dupuytren's Contracture

Not treating it yet is a real option, and often the right one. While the hand still lies flat and the finger works for what you need, watching it with a measurement at each visit is a plan rather than a delay. When it is time, approaches are aimed either at a nodule or at releasing the cord so the finger can open.

Injections

A steroid injection into a nodule is aimed at a tender or growing knot rather than at a cord that has already tightened, to bring down its size and soreness. A collagenase injection uses an enzyme that breaks down the collagen a cord is made of. It is injected into the cord, and a day or two later your doctor straightens the finger to break the softened cord, in the office.

Procedures and Surgery

Needle fasciotomy, also called needle aponeurotomy, divides the cord with the tip of a needle through the skin, with no open incision. Recovery is quick, and the cord can re-tighten sooner than after surgery. Fasciotomy is an operation that opens the palm through an incision to divide the cord and release the tension holding the finger in. Fasciectomy, or partial palmar fasciectomy, removes the thickened tissue and cords instead of only dividing them. It is generally considered for a finger that is severely bent or tissue that has come back.

Therapy

Hand therapy and night splinting after a procedure are where most of the movement gets regained and held. This part is your work, and it changes the result; physical therapy describes how a therapist works.

After any of these treatments a cord can re-form over time, and treatment can be repeated. Which approach fits you depends on which joints are bent and how far, what your hand has to do, and what has been tried before.

Living With Dupuytren's Contracture

Use the tabletop test at home. Once a month is plenty.

Keep using your hand normally. Ordinary gripping, working and lifting are not thought to make this move faster.

Do the therapy and wear the splint after a procedure.

Bring the specific losses to your appointment.

Look after the conditions alongside it. Where diabetes is part of your picture, managing it is part of managing your hands.

Check the other hand now and then. The same tissue change can also appear as firm lumps in the soles of the feet.

Our guide for the people around you, Supporting Someone With Dupuytren's Contracture, covers the tabletop test, the tasks worth mentioning at a visit, and why waiting is a plan.

When to Talk to Your Care Team

Come in when your palm no longer lies flat on a table, when a finger has stopped opening all the way, or when a task you care about has changed. Those are the moments when there is something to decide.

If you have had treatment before and the finger is drawing in again, that is worth a visit rather than a wait, since the options are different the second time.

What Is Fibromyalgia?

Fibromyalgia is a long-term condition of widespread pain, tiredness and unrefreshing sleep.

It is not an inflammatory or an autoimmune disease, and it is not arthritis, even though it is cared for in rheumatology and often travels alongside diseases that are. If you are working out whether what you have is autoimmune, our guide to how we tell autoimmune diseases apart answers that.

Who has it. More women than men, with symptoms most often beginning in middle age, and adolescents develop it too.

It is not life-threatening.

Symptoms of Fibromyalgia

• Widespread pain, on both sides of the body and above and below the waist, lasting at least three months. People describe it as aching, burning, throbbing, stabbing or tingling.
• Tiredness that sleep does not repay, and sleep that is broken or unrefreshing. Poor sleep worsens the pain, and the two feed each other.
• Trouble with concentration, memory and finding words, which people who have it call fibro fog.
• Muscle stiffness, numbness or tingling, and heightened sensitivity to pressure, heat, cold and light.
• Headaches and migraine, digestive problems, bladder and pelvic pain, anxiety and depression, which travel with this condition often enough to be part of the picture.

When to Get Help Now

Having fibromyalgia does not make a new symptom fibromyalgia, and a real emergency is not to be explained away.

Call 911 or go to the emergency department for:

• Chest pain or pressure, or trouble breathing.
• Face drooping, weakness on one side, trouble speaking, or a sudden severe headache unlike any before.
• A joint that is hot, swollen and very painful along with a fever. A joint infection is not fibromyalgia and it is treated urgently.
• Thoughts of harming yourself. Help is available now.

Call your care team the same day for:

• A new symptom you can see, such as a swollen joint without a fever, a rash, or a fever on its own.
• New numbness, weakness or a change in how a limb works.
• Pain that has changed character or moved, rather than pain that is worse.
• Sleep that has collapsed completely, or mood that is sliding.
• A side effect you are considering stopping a medicine over.

When you cannot tell which list you are in, call and describe what is happening; if nobody can be reached and it looks like the first list, go.

Causes of Fibromyalgia

The cause is not known. The working explanation is a trigger acting on a susceptibility: an illness, an injury or a long stretch of sustained stress appears to set the amplification going in someone already predisposed. Stress can play a part in that mechanism, and these symptoms are real.

Risk Factors for Fibromyalgia

Each:

• Being a woman, and being in middle age when symptoms begin.
• A family history. It tends to run in families.
• An existing painful or rheumatic condition. People with rheumatoid arthritis, lupus or osteoarthritis are at higher risk, and having fibromyalgia does not mean the other disease has stopped being active.
• Other chronic pain conditions, and mood disorders, which are named as risk factors for developing it. Being at higher risk is a different claim from the pain being caused by low mood, and this page does not make the second one.

No opened source names anything a person did as a cause.

Diagnosis of Fibromyalgia

Fibromyalgia is not a label handed out when the labs come back normal. Two things are true together.

There is no test that shows fibromyalgia, and normal results are what this condition produces. A normal antinuclear antibody test, a normal inflammation marker, a normal x-ray: each is expected here, and each is ordered to check for a different condition that can produce the same symptoms.

The diagnosis is made positively, from a described pattern. Your care team takes the history, examines you, and works through where the pain is across the body and how severe the whole symptom set has been, with the three-month duration part of the picture.

The sentence you should never be given, in any form: your tests were normal, so this is fibromyalgia.

Treatment Options for Fibromyalgia

The order here is part of the treatment. Movement, sleep and skills come first, with medicines used alongside them rather than in place of them.

Therapy and Rehabilitation

Therapeutic exercise is the best-supported treatment here, and it is the program you run yourself, built to start smaller than you think it should. Physical therapy is the supervised way into it, for anyone set back by starting too hard. Aquatic therapy does the same work in water. Occupational therapy works on pacing, on the shape of a working day, and on the tasks the fog makes harder.

Talking therapies that teach pain and sleep skills are part of first-line care here, delivered by our behavioral health teams.

Medicines

Pain-modulating therapy is the family of medicines used to turn down amplified pain signaling, with better sleep often following from the same medicines. Which one suits you depends on your other conditions and what you take already.

Anti-inflammatory medicines do not generally help the pain of fibromyalgia, because there is no inflammation here for them to treat, though they may still be in your plan for another condition. Opioids and sleeping medicines are not recommended for this condition.

Which parts belong in your plan is decided with your care team and revisited as things change.

Living With Fibromyalgia

The things that change a week here are almost all yours to set.

Move at a size that does not cost you the next three days. Starting too hard is the most common way people conclude that exercise makes this worse. Smaller and regular is what the evidence supports.

Treat sleep as part of the condition rather than as a consequence of it. Poor sleep worsens pain, which is why it gets attention in its own right.

Pace across the week, not just the day. Plan for the good days and the harder ones, without building a life around the harder ones.

Handle the fog practically. Lists, one thing at a time, and no apology attached.

Bring what you have tracked to appointments. People with this condition often arrive with a folder and a timeline. That is competence, and your care team can use it.

Well controlled, fibromyalgia leaves room for a working week and a life outside it, with the pacing running underneath.

If the people around you are still working out what to believe, our guide for partners and family is written for exactly that. Share the link and then let it argue for you. It puts the believing part in somebody else's words, so a bad day stops starting with you making the case for it.

When to Talk to Your Care Team

Bring back what you have tracked, and what has changed since the last visit. And if you were told your results were normal and left there, that is a reason to be seen again. A pattern this specific has a name, and the name has a plan attached to it.