De Quervain’s Stenosing Tenosynovitis
This painful inflammation of the thumb side of the wrist is named after the Swiss surgeon, Fritz de Quervain, who wrote about this condition in 1895.
Anatomy
On the back of the wrist are tendons for muscles that extend or straighten the fingers and thumb, and lift the hand and wrist. These tendons run through six tunnels called compartments. The first dorsal compartment lies over the bony bump at the base of the thumb. Through it pass the tendons for the abductor pollicis longus and the extensor pollicis brevis muscles. Both of these muscles help spread and extend the thumb away from the rest of the hand.
What is De Quervain’s Stenosing Tenosynovitis?
De Quervain’s Stenosing Tenosynovitis is a painful inflammation of the tendons in the first dorsal extensor compartment of the wrist. The tendon sheath lining of this compartment thickens and swells, compressing the tendons, and produces extra synovial fluid. A painful cyst may also form.
Causes
The inflammation may be caused by anything that changes the shape of the compartment or causes swelling or thickening of the tendons. It occurs most often in individuals between the ages of 30 and 50. Women are 8 to 10 times more likely than men to have this condition. Activities requiring sideways motion of the wrist while gripping the thumb, as in hammering, skiing, or some assembly line jobs, may predispose people to develop this condition.
Signs and Symptoms
Pain over the thumb side of the wrist is the primary symptom. It may occur with a sudden onset or gradually. It may radiate pain into the thumb and up the forearm. The pain is made worse with forceful grasping, pinching, or twisting. Swelling over the thumb side of the wrist may be present, as well as some snapping when the thumb is moved. There may be decreased thumb motion due to pain and swelling.
A good diagnostic test is having a positive Finkelstein’s test. In this test, the patient makes a fist with their thumb placed under the fingers. Then the patient bends the wrist away from the thumb and towards the little finger side of the hand. This test is mildly painful to many of us, but if it is very painful then you may have Dequervain’s stenosing tenosynovitis.
Conservative Treatment
Your doctor may recommend a 3 to 6 week trial of anti-inflammatory medication and bracing. Your doctor may also inject the area with a steroid to help decrease the inflammation more rapidly.
If Surgery is Necessary
If the symptoms are long-standing or unresponsive to conservative treatment, surgery may be indicated. This type of surgery is usually performed on an outpatient basis. Full activities may resume 2 weeks after the procedure.