De Quervain syndrome

Not to be confused with De Quervain's thyroiditis.

De Quervain's Syndrome is a medical condition characterized by inflammation of two specific tendons that control thumb movement and their associated tendon sheath, leading to pain on the radial side of the wrist. Pain often escalates during actions that involve gripping or rotating the wrist, and may extend to the thumb or the forearm. As a result, the thumb may become difficult to move in a smooth manner. This condition typically develops gradually.

Risk Factors

Certain repetitive movements, trauma, and rheumatic diseases are identified as possible risk factors. Occupation-related risk factors have been debated; however, some work-related activities like wrist bending, twisting or driving of screws have been linked to De Quervain's syndrome. Repetitive strain injuries where the thumb is held in abduction and extension are believed to be predisposing factors. It is more commonly seen in women and can occur frequently during and after pregnancy.

Pathophysiology

The pathological process in De Quervain's Syndrome involves noninflammatory thickening of the tendons and the synovial sheaths through which the tendons run. The two concerned tendons belong to the extensor pollicis brevis and abductor pollicis longus muscles, which are responsible for thumb movement away from the hand. The pathology is found to be identical in De Quervain's Syndrome occurring in new mothers, suggesting a degenerative, rather than an inflammatory, process.

Diagnosis

Diagnosis primarily relies on clinical examination and the patient's medical history. Imaging techniques such as X-rays can be used to exclude other conditions like fractures or arthritis. A common diagnostic method is the Finkelstein's test, where the examiner moves the hand into a certain position while the patient's thumb is held within their fist. The occurrence of sharp pain along the distal radius can indicate De Quervain's syndrome.

Treatment

The treatment strategy typically involves avoiding activities that exacerbate symptoms, administering pain relief medications such as NSAIDs, and thumb splinting. If these conservative measures are ineffective, steroid injections or surgery may be recommended.

See Also

De Quervain syndrome Resources
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Tendonitis Repetitive strain injury NSAIDs Rheumatic diseases