What Is De Quervain's Tenosynovitis?

Inflammation of the Extensor Pollicus Longus Tendon

De Quervain's tenosynovitis
fatihhoca/E+/Getty Images

A common site of tendon irritation around the wrist occurs in the first doral extensor compartment. Tendons attach muscle to bone. The condition, named after a Swiss surgeon who described it in 1895, is known as De Quervain's Disease and involves two tendons: the extensor pollicis brevis and abductor pollicis longus. The two tendons pass through an osteoligamentous tunnel. The tunnel is formed by a groove in the radius and a ligament the overlies the tunnel.

   

De Quervain's Disease is associated with inflammation and pain of the involved tendons which are employed when the thumb is extended. Swollen tendons can cause friction in the tunnel or in the sheath which covers them. The resulting pain can run from the forearm to the base of the thumb, including the side of the wrist at the base of the thumb. In severe cases, movement of the tendons can cause a creaking sound.

Tenosynovitis is the medical term for inflammation of the lining of the sheath that surrounds a tendon. De Quervain's tenosynovitis involves inflammation of the lining of the sheath of the two aforementioned tendons. It may be caused by repetitive activity, and may make thumb motion painful and difficult, especially when there is a movement to pinch with the thumb, to grip, or to grasp.

Most often, De Quervain's tenosynovitis affects women in the age range of 30 to 40 years old.

Men and women of any age can develop the condition, though. De Quervain's tenosynovitis is a common tendinopathy in postpartum women, largely due to hand and wrist motions and hand positions involved in caring for an infant.

Early Symptoms and Diagnosis

The primary symptom associated with De Quervain's tenosynovitis is a pain on the thumb side of the wrist.

The pain may occur gradually or suddenly, but it is usually made worse with the use of the thumb. Swelling may be visible over the thumb side of the wrist.

The Finkelstein test is used for diagnosis of De Quervain's tenosynovitis. If tested, you will be asked to make a fist with your thumb positioned in the palm of your hand. When the wrist is bent towards the little finger side, swollen tendons are pulled through in a way that causes pain.

Treatment

Treatment is geared towards relieving pain and improving mobility and function. Treatment may involve:

  • Splinting for several weeks to immobilize the wrist and avoid activity that might provoke the irritation. The wrist should be in slight extension and the position of the thumb is abducted in a thumb spica splint.
  • 2 to 4-week course of an NSAID (nonsteroidal anti-inflammatory drug) can be helpful to control symptoms.
  • A local cortisone injection is considered a second-line treatment if splinting alone is inadequate.
  • Finally, surgery may be considered if conservative treatment fails to produce a sufficient response. Surgery involves releasing the sheath over the involved tendons.

    Sources:

    Kelley's Textbook of Rheumatology. Elsevier. Ninth edition. Chapter 50. Hand and Wrist Pain. De Quervain's Disease. Page 715. Accessed 12/14/15.

    De Quervain's Disease. Cleveland Clinic. Accessed 12/14/15.
    https://my.clevelandclinic.org/services/orthopaedics-rheumatology/diseases-conditions/de-quervains-disease

    De Quervain's Tendinosis. OrthoInfo. American Academy of Orthopaedic Surgeons. December 2013.
    http://orthoinfo.aaos.org/topic.cfm?topic=a00007

    Continue Reading