De-Quervain's Tenosynovitis
De Quervain tenosynovitis (dih-kwer-VAIN ten-oh-sine-oh-VIE-tis) is a painful condition affecting the tendons on the thumb side of the wrist. If you have de Quervain tenosynovitis, you will probably feel pain when you turn your wrist, grasp anything or make a fist.
De-Quervain's tenosynovitis
De Quervain's tenosynovitis is swelling of the tendons that run along the thumb side of the wrist and attach to the base of the thumb. This occurs when the tendons are constricted by the sheath that they run through to get from the wrist to the hand.
De Quervain's tenosynovitis affects the abductor pollcis longus (APL) and the extensor pollcis brevis (EPB). These are two of the main tendons to the thumb that assist with bringing the thumb out away from the index finger (APL) and straightening the joints of the thumb (EPB). These two tendons arise from muscles in the forearm and then run together in a sheath that keeps them close to the bone as they cross over from the thumb side of the wrist into the hand.
To determine whether you have De Quervain's tenosynovitis, your doctor may touch along the thumb side of your wrist, looking for pain and swelling. You may be asked to perform the Finkelstein/Eichhoff test, which involves placing your thumb in your palm, grasping it with your other fingers, and bending your wrist toward your little finger.
Surgery may be recommended if symptoms are severe or do not improve with non-operative management. The goal of surgery is to release the tendon sheath to make more room for the irritated tendons. When done correctly, this can relieve the symptoms of De Quervain's tenosynovitis without affecting hand/wrist function.
Most patients with De Quervain's tenosynovitis do very well and are ultimately relieved of their symptoms with nonsurgical and/or surgical treatment. Fifty to 80% of patients can be successfully treated nonsurgically with splints, NSAIDs, and injections. The remaining patients typically respond well to surgery.
de Quervain's tenosynovitis is an overuse disease that involves a thickening of the extensor retinaculum, which covers the first dorsal compartment. A case study approach was utilized in this article to demonstrate many of the available medical and occupational therapy modalities to treat this condition. A 34-year-old right hand-dominant female who works in a daycare facility presents with radial side wrist pain during lifting activity for the past 4-6 weeks. The patient was diagnosed with de Quervain's tenosynovitis and conservative care was initiated. Conservative care involved anti-inflammatory medication and corticosteroid injections as well as occupational therapy to include splinting, activity modification, modalities, manual treatment, and therapeutic exercise. Although conservative care assisted the patient with her symptoms initially, she returned with increased pain and discomfort after 2 months time. At that point, surgery was discussed and performed to release the first dorsal compartment as well as the sub-compartment. The patient was provided with a splint postoperatively and initiated occupational therapy for edema and scar management, therapeutic exercise, and desensitization. Ultimately, the patient was able to return to work pain free.
The exact etiology of de Quervain tenosynovitis is unknown. De Quervain tenosynovitis symptoms result from non-inflammatory fibrous thickening of the first extensor compartment tendon sheath, which surrounds the APL and EPB, at the level of the radial styloid process. Rather than secondary to an acute inflammatory process, the thickening is a result of fibrous tissue deposits and increased vascularity along the extensor retinaculum. This thickening results in repetitive tension on the tendons causing swelling which restricts gliding of the tendons through the sheath.3 Symptoms are triggered by repetitive thumb movement, along with ulnar and radial wrist deviation.
De Quervain tenosynovitis may occur in conjunction with rheumatoid arthritis. Therefore can consider obtaining a complete blood count, erythrocyte sedimentation rate, and rheumatoid panel if suspected.
De Quervain tenosynovitis is a condition that causes pain and swelling at the base of the thumb and the thumb side of the wrist. In de Quervain tenosynovitis, swelling and thickening of the soft tissues around the thumb tendons cause pain with common activities, particularly with picking up or grasping objects.
Although the majority of patients with de Quervain tenosynovitis are women between 30 and 50 years old, this condition can affect anyone at any age. There are several factors that can contribute to the swelling of the thumb tendons and increase the risk for developing de Quervain tenosynovitis:
If you are considering treatment for de Quervain tenosynovitis, the University of Michigan hand surgeons will guide you, from consultation to recovery, to the best treatments for your individual needs. Our hand surgeons have dual appointments in Orthopaedic and Plastic Surgery with a specialization in Hand. Patients may be seen in the Orthopaedic Clinic or the Plastic Surgery Clinic for treatment of hand conditions, or referred to Physical Medicine and Rehabilitation for non-surgical treatment.
Although the exact cause of de Quervain's tenosynovitis is unknown, medical experts believe it is due to chronic overuse of the wrist. Repetitive movements day after day can irritate protective sheaths that surround two tendons in your lower thumb and wrist that enable you to grip, pinch and grasp things with your hands.
In people with de Quervain's tenosynovitis (also known as de Quervain's syndrome, de Quervain's disease, or de Quervain's tendinosis), the tendons become swollen or the sheath thickens. This puts pressure and friction on the tendons and inhibits their ability to slide smoothly through the sheath, causing inflammation and pain.
De Quervain's tenosynovitis most often happens from overuse, when you do too much of a certain type of movement (repetitive stress injury). It may also result from a direct injury to the thumb or rheumatoid arthritis.
If thumb or wrist pain is interfering with your daily activities, visiting a hand specialist can help. The hand surgeons and occupational therapists at NewYork-Presbyterian Columbia Orthopedics are experts in the care of de Quervain's tenosynovitis and other conditions affecting the hand, wrist, and arm. Our team will carefully assess your symptoms and provide the most effective treatment to meet your needs. Call us to make an appointment for a consultation.
The symptoms of De Quervain's tenosynovitis include pain and tenderness on the side of the wrist at the base of the thumb. You may also have a little swelling and redness in the area. Your symptoms may get worse while making a fist, grasping or gripping things, or turning the wrist. You may experience a "catching" or "snapping" sensation while moving your thumb.
De Quervain's Tenosynovitis is a hand condition affecting a patient's ability to control movement of their thumb. There are two tendons which control thumb movements. These tendons are housed in a small tunnel or sheath which is lined with a soft, smooth tissue layer called synovium. Synovium enables the smooth gliding movements of the tendons within the sheath. Inflammation of the synovium lining affects the ability to move the thumb freely and is the cause of De Quervain's tenosynovitis.
De Quervain's tenosynovitis is diagnosed based on a simple test called the Finkelstein Test. Your doctor will ask you to make a fist with your fingers closed over the thumb and the wrist angled towards the pinky finger. This maneuver is usually painful over the tendons in the thumb side of the wrist in patients with this condition. 041b061a72