DE QUERVAIN´S TENDONITIS
INTRODUCTION
The De Quervain’s tenosynovitis is an inflammation of the tendon sheath of the thumb (long abductor and short extensor) at the outer edge of the wrist. The inflammation causes the compartment around the tendon to swell and enlarge, making thumb and wrist movement painful.
The cause of de Quervain’s tendonitis is an irritation of the tendons at the base of the thumb, usually caused by taking up a new, repetitive activity. New mothers are especially prone to this type of tendonitis: caring for an infant often creates awkward hand positioning, and hormonal fluctuations associated with pregnancy and nursing further contribute to its occurrence.
SYMPTOMS
Pain over the thumb-side of the wrist is the main symptom. The pain may appear either gradually or suddenly, and pain is located at the first dorsal compartment at the wrist. Pain may radiate down the thumb or up the forearm. Hand and thumb motion increases pain, especially with forceful grasping or twisting. There may be an occasional “catching” or “snapping” when moving the thumb.
DIAGNOSIS
Finkelstein test is always positive: the patient makes a fist with the fingers clasped over the thumb. The wrist is then bent in the direction of the little finger .This maneuver should be quite painful for the person with de Quervain’s tendonitis. Ultrasonography and MRI are also useful.
TREATMENT
The goal is to relieve the pain caused by the irritation and swelling. It may be useful resting the thumb and wrist by using a splint or doing oral anti-inflammatory medication. Steroid injections may be effective as another treatment option. Each of these non-operative treatments helps reduce the swelling, which typically relieves pain over time. In some cases, simply stopping the aggravating activities may allow the symptoms to go away on their own.
When symptoms are severe or do not improve, surgery may be recommended. Surgery opens the compartment to make more space for the inflamed tendons, which breaks the vicious cycle where the tight space causes more inflammation. Normal use of the hand can usually be resumed once comfort and strength have returned.
