De Quervain's tenosynovitis

De Quervain's Tenosynovitis

De Quervain's tenosynovitis is a painful condition affecting the tendons on the thumb side of the wrist. It is named after the Swiss surgeon Fritz de Quervain, who first identified the condition in 1895. This condition is characterized by inflammation of the sheath, or synovium, that surrounds the two tendons that control movement of the thumb.

Anatomy and Pathophysiology

The tendons involved in De Quervain's tenosynovitis are the abductor pollicis longus and the extensor pollicis brevis. These tendons pass through a fibrous tunnel, or sheath, located on the radial side of the wrist. Inflammation of the synovial sheath can lead to swelling and thickening, which restricts the movement of the tendons and causes pain.

Causes

The exact cause of De Quervain's tenosynovitis is not always clear, but it is often associated with repetitive hand or wrist movements. Activities that involve pinching, grasping, or wringing motions can contribute to the development of this condition. It is also more common in women, particularly during pregnancy and postpartum periods, possibly due to hormonal changes and increased hand use.

Symptoms

Common symptoms of De Quervain's tenosynovitis include:

• Pain and tenderness at the base of the thumb
• Swelling near the base of the thumb
• Difficulty moving the thumb and wrist when performing activities that involve grasping or pinching
• A "sticking" or "stop-and-go" sensation in the thumb when moving it

Diagnosis

Diagnosis of De Quervain's tenosynovitis is primarily clinical. A healthcare provider will perform a physical examination and may use the Finkelstein's test, which involves bending the thumb across the palm and then bending the fingers down over the thumb. The wrist is then bent towards the little finger. Pain during this maneuver is indicative of De Quervain's tenosynovitis.

Treatment

Treatment options for De Quervain's tenosynovitis include:

• Rest and avoidance of activities that exacerbate symptoms
• Splinting of the thumb and wrist to immobilize the area
• Nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and swelling
• Corticosteroid injections to decrease inflammation
• Physical therapy to strengthen the wrist and thumb
• Surgery, in severe cases, to release the tendon sheath and relieve pressure

Prognosis

With appropriate treatment, most individuals with De Quervain's tenosynovitis experience significant relief of symptoms. However, if left untreated, the condition can lead to chronic pain and limited thumb movement.

Also see

• Tendinitis
• Carpal tunnel syndrome
• Trigger finger
• Repetitive strain injury