At this age, every other person suffers from some disease. Why is that, you may ask. It’s because of the busy lifestyle everyone has nowadays. People neglect minor discomforts to avoid going to the doctor because they may not fit their jam-packed schedule. But these minor discomforts, if ignored, don’t take long to turn into a chronic condition.

Read on to understand what is De Quervain’s Tenosynovitis.

What is De Quervain’s Tenosynovitis?

De Quervain’s tenosynovitis is an inflammatory condition that results in chronic pain if unchecked 1.

In this condition, thumb and Wrist tendons get inflamed. Hence, both the thumb and wrist movements become limited because of the pain.

In medical terminology, De Quervain’s tenosynovitis thickens the extensor retinaculum, which is present on the posterior side of the wrist. The retinaculum covers the first dorsal compartment, which is the thumb. The stenosing tenosynovitis of the thumb can occur in this condition.

It characterizes as a disorder of muscles and skeleton that is noncomplicated as compared to other wrist disorders such as Guyon’s canal or carpal tunnel syndrome.

The pain starts to emerge on the radial side of the hand, which causes the impairment of the thumb and painful aches during wrist movements.

Causes of De Quervain’s Tenosynovitis

The overuse or repetitive actions, strain, injury, or trauma to the wrist and thumb can result in de Quervain’s tenosynovitis.

Tendons are strong cord or rope-like structures that attach your muscles to bones. The tendons of the wrist and thumb are in a covering called a sheath. In daily routine, the tendons of both wrist and thumb move quickly. But due to repetitive hand movements, friction can occur between the tendons. The rubbing force can cause thickening or swelling of the tendon sheath, which then gets inflamed and cause irritation and pain in the thumb muscles.

Because of the inflammation, the nearby nerves can also get compressed, and the pain can radiate from the hand towards the forearm and arm 2.

The causes of De Quervain’s Tenosynovitis may also include any direct injury to the wrist, as the damage can result in the restriction of movements 3.

De Quervain’s Tenosynovitis can also get triggered by other diseases such as rheumatoid arthritis, which causes inflammation of the joints. Diabetes, an increased risk of skeletal disorders, or wrist infections can also lead to the disease 4.

It is more common in women than in men. Women during the pregnancy or breastfeeding phase can develop de Quervain’s tenosynovitis because of the awkward hand placements used to care for the baby.

Daily movements such as writing with a pencil, carrying heavy grocery bags, lifting a child impose a risk to the disease. Playing sports that include rackets and basic activities that involve twisting or gripping the wrist can also cause it 5.

Signs of De Quervain’s Tenosynovitis:

The signs and symptoms of De Quervain’s Tenosynovitis include6:

• Tenderness on the radial side of the wrist.
• Pain near the end of the thumb.
• Swelling near the end of the thumb.
• Pain while forming a fist.
• Difficulty in moving or rotating the wrist.
• Discomfort while grasping or pinching.
• Pain can occur slowly or suddenly.
• When moving, the thumb has a snapping sensation.
• When the tendon moves in the sheath, you can hear a creaking sound.

Diagnosis of De Quervain’s Tenosynovitis

To diagnose De Quervain’s Tenosynovitis, your doctor may touch your hand and apply pressure on the lateral side of the wrist and at the base of the thumb. It will help determine the pain and swelling 7.

Your doctor will also perform a Finkelstein/Eichhoff test to diagnose De Quervian’s Tenosynovitis. This test involves placing your thumb in your palm. Then grasping your other fingers, make a fist. Lastly, bend your wrist towards your little finger. If you have pain, tenderness, and swelling at the base of your thumb, the signs indicate disease 8.

Treatment of De Quervain’s Tenosynovitis

The main focus of treating De Quervain’s Tenosynovitis is to reduce inflammation and relieve the pain.

De Quervain’s Tenosynovitis treatment includes two methods: Non-surgical and the other is Surgical methods 9-12.

Non-surgical Method:

The non-surgical method includes :

• Applying heating pads or ice packs to the affected area.
• Avoid repetitive hand movements.
• Restricting your thumb and wrist by wearing a splint or brace to help keep the hand in a straight and comfortable position.
• Avoid actions that can cause more pain and inflammation.
• Take pain reliever medicines which are non-steroidal anti-inflammatory drugs (NSAIDs). These include naproxen or ibuprofen.
• Get numbing injections (local anesthetic) or steroids injections such as Corticosteroid injection, effectively reducing inflammation and pain.
• The corticosteroids injections are given into the tendon sheath to reduce the swelling. If the treatment starts within the first six weeks of symptoms, the patient can recover after only one injection.
• Perform exercises recommended by the doctors

Surgical Method

Surgery is required if the patient’s condition worsens and the non-surgical methods fail to provide relief.

During surgery, the doctor releases the tendon sheath and opens it to let out the pressure so the tendons can glide smoothly over each other without any friction. The hand and wrist movements go back to normal when the surgery is successful. After the surgery, your orthopedic will advise you to physical therapy to strengthen your wrist and thumb and prevent future problems.

Complications:

Complications such as limited wrist motion and difficulty using hand and wrist in daily life may occur in De Quervain’s Tenosynovitis when untreated.

Recovery:

Recovery of De Quervain’s Tenosynovitis in most patients goes well without any complications. About 80% of the patients recover using non-surgical methods, and the remaining patients get treated with surgery.

Complications of the surgery are rare. But patients with diabetes may respond differently to the treatment methods. They are less successfully treated with injections and may face complications such as injury or wound healing problems in the surgical techniques.

References

1. de Quervain’s Tenosynovitis: Symptoms, Causes, Diagnosis, Treatment. Accessed February 27, 2022. https://www.webmd.com/rheumatoid-arthritis/guide/de-quervains-disease

2. Stahl S, Vida D, Meisner C, Stahl AS, Schaller HE, Held M. Work related etiology of de Quervain’s tenosynovitis: A case-control study with prospectively collected data Pathophysiology of musculoskeletal disorders. BMC Musculoskeletal Disorders. 2015;16(1):1- 10. doi:10.1186/S12891-015-0579-1/TABLES/3

3. OZ Younghusband JB. De Quervain’s disease: stenosing tenovaginitis at the radial styloid process. Can Med Assoc J. 1963;89:508-512.

4. McAuliffe JA. Tendon disorders of the hand and wrist. J Hand Surg Am. 2010;35(5):846-853. doi:10.1016/j.jhsa.2010.03.001

5. Y Minamikawa CPWCFS. De Quervain’s syndrome: surgical and anatomical studies of the fibroosseous canal. Orthopedics. 1991;14(5):545-549.

6. Moore JS. De Quervain’s tenosynovitis. Stenosing tenosynovitis of the first dorsal compartment. J Occup Environ Med. 1997;39(10):990-1002. doi:10.1097/00043764-199710000-00011

7. Mak J. De Quervain’s Tenosynovitis: Effective Diagnosis and Evidence-Based Treatment. Workrelated Musculoskeletal Disorders. Published online December 10, 2018. doi:10.5772/INTECHOPEN.82029

8. Goubau JF, Goubau L, van Tongel A, van Hoonacker P, Kerckhove D, Berghs B. The wrist hyperflexion and abduction of the thumb (WHAT) test: A more specific and sensitive test to diagnose de Quervain tenosynovitis than the Eichhoff’s Test. Journal of Hand Surgery: European Volume. 2014;39(3):286-292. doi:10.1177/1753193412475043

9. Hasan T, Fauzi M. De quervain’s tenosynovitis and phonophoresis: A randomised controlled trial in pregnant females. de quervain. Journal of Orthopaedics, Trauma and Rehabilitation. 2015;19(1):2-6. doi:10.1016/J.JOTR.2014.04.001

10. Goel R, Abzug JM. de Quervain’s tenosynovitis: a review of the rehabilitative options. Hand (New York, NY). 2015;10(1):1-5. doi:10.1007/s11552-014-9649-3

11. Ippolito JA, Hauser S, Patel J, Vosbikian M, Ahmed I. Nonsurgical Treatment of De Quervain Tenosynovitis: A Prospective Randomized Trial. Hand. 2020;15(2):215-219. doi:10.1177/1558944718791187

12. To P, McClary KN, Sinclair MK, et al. The Accuracy of Common Hand Injections With and Without Ultrasound: An Anatomical Study. Hand. 2017;12(6):591-596. doi:10.1177/1558944717692086

13. Ilyas A, Ast M, Schaffer AA, Thoder J. de Quervain tenosynovitis of the wrist. Journal of the American Academy of Orthopaedic Surgeons. 2007;15(12):757-764. doi:10.5435/00124635- 200712000-00009