De Quervain's Tendinopathy
What is De Quervain's tendinopathy?
De Quervain’s Tenosynovitis is a painful irritation of the tendons on the thumb side of the wrist. A Swiss surgeon, Fritz de Quervain, described the problem in 1895. Passing over the back (or dorsal surface) of the wrist are the tendons that straighten the thumb, fingers, and wrist. These tendons run through six tunnels (compartments) under a thick fibrous layer called the extensor retinaculum.
De Quervain’s tenosynovitis affects the tendons of the first dorsal compartment. The lubricating sheath lining this tunnel thickens and swells, giving the enclosed tendons less room to move. Fine fibres of scar (adhesions) may form between the lining sheath and the tendons.
What causes of De Quervain's tendionpathy?
The tendon irritation may be caused by anything that causes swelling or thickening of the tendons. Overuse, particularly in parents caring for infants, and inflammatory processes are common causes but frequently the cause is unknown.
Phone
02 6185 2705
Fax
02 6185 2705
Location
Suite 4A, Level 2
Peter Yorke Building
173 Strickland Cres
Deakin ACT 2600
Risk factors for De Quervain's tendinopathy
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People between 30 and 50 years of age.
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10 times more common in women.
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Mothers with young infants due to a combination of overuse and hormone-related tendon swelling.
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Repetitive activities can precipitate the symptoms.
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Inflammatory conditions such as that cause tendon swelling (rheumatoid arthritis, psoriatic arthritis).
What are the signs & symptoms?
The main symptom is pain over the thumb side of the wrist. It may develop suddenly or gradually. It is worse with use of the hand and thumb, especially with strong grasping, pinching, and twisting. There may be swelling at the site of pain and when very severe “snapping” when the thumb is moved. Thumb movement may be reduced.
A positive Finkelstein’s test is usually present. In this test, the patient makes a fist with the thumb placed in the palm and bends the wrist. This test will cause pain in patients when de Quervain’s tenosynovitis is present. (See image).
Occasionally a small ganglion can form over the first dorsal compartment. This is often mistaken for bone as the cyst is usually quite hard due to the pressure of the fluid within the cyst.
How is it diagnosed?
Frequently the diagnosis is clear from the history and examination findings. Ultrasound may occasionally be used to confirm the diagnosis.
Treatment Options
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Steroid injection & splinting for 4 weeks followed by physiotherapy.
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Surgical release of the first dorsal compartment.
Non-Operative Treatment
The initial treatment is to rest the wrist in a splint that immobilizes the wrist and thumb for 4 weeks. A steroid injection into the tendon sheath is usually recommended as this is a strong anti- inflammatory that helps reduce the tendon swelling. The splint is worn day and night and is only taken off to shower or wash the hand. After four weeks in a splint, the hand therapist will start a series of stretching exercises to regain movement. If the symptoms are longstanding (more than 3 months) or the non-operative treatment with a splint and steroid injection has failed, surgery may be required.
Surgical Treatment
The first dorsal compartment release is a minor operation and can performed under general anaesthetic or local anaesthetic. A 1.5-2 cm incision is made in the skin crease at the wrist and the first compartment is divided so that there is more room for the tendons to glide with movement. Dissolving stitches, steri-strips and a bandage with a fibreglass splint are applied to rest the wrist for two weeks. Long-acting anaesthetic makes the area numb for 6-8 hours. Most people have very little discomfort, requiring only panadol after surgery.
Risks of Surgery
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Nerve injury - very small risk of a permanent numb patch on the back of the thumb.
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Incomplete release - very low risk.
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Tendon instability - very rarely the tendons can become unstable and require a second surgery.
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Recurrence of symptoms - extremely rare.
Recovery
2 Days: Pain relief may be required, and the hand should be kept elevated to chest height.
2 weeks: Dressings & splint removed, and an exercise program is started. Recommence driving.
2 months: Completing all light daily activities with minimal discomfort.
3-4 months: Returned to normal activities without discomfort. All swelling resolved.