DeQuervain’s Tenosynovitis

What is De Quervain’s Tenosynovitis?

De Quervain tenosynovitis is a painful condition that affects the tendons on the thumb’s side of your wrist. This condition results in pain when a person attempts to rotate the wrist, grab an object or make a fist.

The exact cause of De Quervain’s tenosynovitis is unknown. However, any activity that requires repetitive hand or wrist movement, e.g., playing golf or digging, can exacerbate the condition.

It is also known as radial styloid tenosynovitis, describing the anatomical components of the dysfunction. Also called Washer Woman’s wrist, it is named after Fritz de Quervain, a Swiss surgeon who documented five case reports on it in 1895.

Figure A:Shows swelling of the thumb tendons

De Quervain’s Tenosynovitis Signs and Symptoms

The main symptom of the condition is pain over the thumb’s side of the wrist. The onset of pain could be gradual or sudden and is typically localized to the wrist’s first dorsal extensor compartment. The pain may radiate distally to the forearm or proximally down the thumb.

Motion using the hand and thumb may result in pain exacerbation, particularly when grasping or twisting forcefully. Patients may also notice swelling over the base of the thumb that could progress to a cyst.

There are various movement restrictions involving the fist, especially in pinching and twisting due to the pain and swelling. Occasionally there could be “catching” or “snapping” when using the thumb.

Numbness of the thumb and index finger’s dorsal aspect may result from irritation of the nerve overlying the tendon sheath.

Figure B:Shows swelling of the thumb tendons

De Quervain’s Tendonitis Causes

Although this tendonitis’s specific cause is not known, chronic overuse of the wrist is commonly associated with the condition.

Tendons are fibrous structures that connect muscles to bones. When you grasp, grip, pinch or wring anything with the hand, two tendons in your wrist and thumb usually glide over each other within the tunnel that attaches them to the thumb’s base.

When this type of motion is carried out repeatedly, it could irritate the sheath surrounding these two tendons leading to swelling and tension, limiting their movement.

There are less common specific causes of De Quervain's tenosynovitis include:

Arthritis, e.g., rheumatoid arthritis
Direct trauma to the wrist. Scarring of the tendon sheath can result in movement restriction.

There are risk factors for the condition such as:

Age: It is most common in people between 30 and 50 years.
Sex: Women are more likely to have these symptoms.
Pregnancy: There is some link between the condition and pregnancy.
Jobs or hobbies that involve repetitive wrist and hand movements.

Diagnosis

Diagnosis is typically clinical using the Finkelstein test. During the test, the patient is asked to make a fist with the fingers crossed over the thumb. The fist is then flexed in the direction of the little finger. This maneuver can be painful if the person is suffering from this tendonitis.

De Quervain's Tenosynovitis Treatment Options

The first line of treatment is applying heat or ice to the affected area and taking a nonsteroidal anti-inflammatory drug (NSAID). If the condition persists, splinting of the thumb and wrist is typically the next step. However, many patients dislike splinting of the thumb due to the restrictions, so they do not wear it consistently. Another line of treatment is with corticosteroid injection therapy. Here, local anaesthesia like lidocaine and a long-acting corticosteroid is injected into the area either simultaneously or one after the other. Hyaluronic acid may sometimes be added to the therapy to reduce recurrence rates.

Surgery

Severe and recurrent cases are treated with the surgical decompression of the tendon sheath. It is performed as an outpatient surgery under local or regional anesthesia, depending on the surgeon's preference. A small incision is performed at the area bearing in mind the nerve branches just under the skin. Next, the roof of the tunnel containing the affected tendons is split, widening it. As the split heals, the roof forms once more, but it is now wide enough for the tendons to move freely. If symptoms persist, a steroid and lignocaine injection may help reduce pain. In recalcitrant cases, surgery may be necessary to release or reconstruct the thickened tendon sheath.

I. Complications

Although De Quervain's tenosynovitis surgical treatment is minor, there could be some lasting and serious complications. They include:

Nerve injury
Subluxation of released tendons
Adhesions in the scar

II. Success Rate

The prognosis of De Quervain's tenosynovitis is excellent. Patients usually return to normal function after the inflammation subsides following treatment. To prevent future occurrences, bracing may be used while performing repetitive wrist movements.

Exercises / Physical Therapy

Thumb lifts

Place your hand on a flat surface palm facing up.
Extend the thumb away from the palm to make a C shape.
Hold it in place for 5 to 10 seconds.
Repeat this exercise 10 to 15 times.

Passive thumb metacarpophalangeal joint flexion

The hand is held in front of the person and rotated to keep the little finger facing down and thumb facing up.
Use fingers of the other hand to bend the thumb towards where it connects to the palm.
Hold for 20 or 30 seconds.
Repeat exercise two to four times.

Finkelstein stretch

Place arms in front.
Bend thumb towards palm.
Use the other hand to gently stretch the thumb and wrist downward until the stretch is felt at the side of the wrist.
Hold for 15 to 30 seconds.
Repeat four times.

Frequently Asked Questions

How to Prevent De Quervain's Tenosynovitis?

De Quervain's tenosynovitis can be prevented by avoiding wrist stress. Take frequent breaks to rest if you are using your hands. One could also wear a brace or splint on their thumb and wrist.

Will De Quervain's tenosynovitis go away on its own?

The tenosynovitis may resolve spontaneously if the aggravating activity is avoided.

De Quervain's tenosynovitis, how long to wear a splint?

A patient may need to wear a splint 24 hours a day for 4 to 6 weeks.

Can De Quervain's tenosynovitis cause elbow pain?

The pain from the tenosynovitis may radiate distally along the forearm and cause elbow pain.

Can De Quervain's tenosynovitis recur after surgery?

Recurrence of symptoms after surgical treatment is possible. A change in the pattern of hand use may be necessary to prevent a recurrence. Sometimes this may be due to inadequate release of the tendon. Not sure if you're experiencing signs and symptoms of DeQuervain's Tenosynovitis? Speak to our hand care team to find out if this is the medical condition you have at +65 6733 9093. Or book an appointment with our hand specialists for a consultation on your symptoms and treatment options.