DE QUERVAIN’S TENOSYNOVITIS

De Quervain’s disease is a stenosing tenosynovitis of the tendons around the base of the thumb. Athletes, hand workers and PC users, considered to be at risc. Generally persons who require forceful grasp, combine with repetitive use of the thumb in ulnar deviation are in high risk team for the disease.

Anatomy

De Quervain's tenosynovitis affects two thumb tendons the abductor pollicis longus and the extensor pollicis brevis tendons.

The extensor retinaculum covers the tendons and holds them adjacent to the radial styloid and create a fibroosseous tunnel. Repeatedly performing hand and thumb motions such as grasping, pinching, squeezing, or wringing may lead to the inflammation of tenosynovitis.

This inflammation can lead to swelling, which hampers the smooth gliding action of the tendons within the tunnel.

Arthritic diseases that affect the whole body, such as rheumatoid arthritis, can also cause tenosynovitis in the thumb. In other cases, scar tissue from an injury can make it difficult for the tendons to slide easily through the tunnel.

Symptoms

The patients typically complain of:
Pain over the base of the thumb that worsen with wrist and thumb motion.
Swelling may be seen over the thumb side of the wrist.
A "catching" or "snapping" sensation may be felt when moving the thumb.


Swelling in tenosynovitis area.

Diagnosis

Reproduction of pain with ulnar deviation of the wrist while the thumb is adducted is typical but not pathognomonic for the de Quervain’s tenosynovitis. However carpometacarpal arthritis or underlying disease can result a false positive test.

Test: A. The patient grasps the thumb
          B. The wrist is ulnary deviated.

Reproduction of pain at the radial styloid is a positive test.

CONSERVATIVE TREATMENT
THERAPY: 

Conservative treatment

The goal in treating de Quervain's tendinitis is to relieve the pain caused by irritation and swelling.

Splints. Splints may be used to rest the thumb and wrist.

Anti-inflammatory medication (NSAIDs). These medications can be taken by mouth or injected into that tendon compartment. They may help reduce the swelling and relieve the pain.

Avoiding activities that cause pain and swelling. This may allow the symptoms to go away on their own.

Corticosteroids. Injection of corticosteroids into the tendon sheath may help reduce swelling and pain.

Cortisone injection inside the tendons sheath.

OPERATIVE TREATMENT
THERAPY: 

OPERATIVE TREATMENT

If de Quervain's disease does not respond to conservative medical treatment, surgery may be recommended.

Surgical release of the tight covering of the tendon eliminates the friction that causes inflammation, restoring the tendons' smooth gliding capability.


Skin incision.

What happens during surgery?

Surgery for de Quervain’s is an outpatient procedure and is usually done under local anesthesia. Surgical release of the tight sheath eliminates the friction that worsens the inflammation, thus restoring the tendons’ smooth gliding capability.

What happens after surgery?

The wound is closed and a compressive dressing is applied. Early on, a splint is used for comfort. The doctor typically prescribes pain medication as well as a therapy program for increasing the strength and range of motion of the thumb and wrist.

REHABILITATION: 

Pain and symptoms generally begin to improve after surgery, but tenderness in the area of the incision may persist for several months. Occupational therapy for six to eight weeks is usually required.

Therapists attend to wound and scar management issues and also use a series of exercise to encourage the thumb tendons to glide easily within tunnel. As therapy progresses, other exercises are used to strengthen and stabilise the muscles and joints in the hand and thumb. Most importantly, the therapist provides careful instructions and guidelines to minimise the chance if recurrence.

The patient can generally return to full function after the inflammation quiets down with treatment.