De Quervain Syndrome

De Quervain’s tenosynovitis is a painful condition that affects the tendons of the base of the thumb (long thumb extensor, short thumb extensor). Although the exact cause of the disease is not known, any activity that relies on repetitive movements of the wrist or thumb can trigger or worsen the disease.

Symptoms of De Quervain’s tenosynovitis include pain and swelling at the base of the thumb and at the styloid process of the radius. There is also difficulty in movement and a “twinge” feeling in the thumb and wrist. If the condition is prolonged without treatment, the pain may spread to the thumb, forearm or both.

The constant repetition of a particular movement can irritate the sheath around the two tendons (the sheath), causing thickening and swelling that restricts their movement. Other causes of De Quervain’s tenosynovitis include direct injury to the wrist or tendon, scar tissue that can restrict tendon movement, and inflammatory arthritis such as rheumatoid arthritis

Risk factors for De Quervain’s tenosynovitis include age 30-50, female gender, pregnancy, pregnancy, postpartum and caring for babies. Repeated lifting of infants involves the use of thumbs as leverage and may also be associated with the condition.

The diagnosis of De Quervain’s tenosynovitis is clinical and based on the Finkelstein diagnostic test. Imaging tests are generally not needed to diagnose the disease.

The treatment of De Quervain’s tenosynovitis aims to reduce inflammation, preserve movement in the thumb and prevent recurrence. If treatment is started early, symptoms are expected to improve within four to six weeks. If De Quervain’s tenosynovitis starts during pregnancy, symptoms are likely to end around the end of pregnancy or breastfeeding.

Administration of non-steroidal anti-inflammatory drugs as well as local corticosteroid injections may reduce pain and swelling. If treatment is started within the first six months of symptoms, most people make a full recovery after a corticosteroid injection, often after a single injection. Initial treatment of De Quervain’s tenosynovitis may include immobilization of the thumb and the pinna with a splint avoiding repetitive thumb movements, application of ice to the affected area, and physical therapy.

If the case is more severe, surgery may be performed. The surgery is day surgery and is performed under local anaesthesia. The operation consists of surgically opening the tendon sheath to release the pressure and allow the tendons to slide freely. The sutures are cut 3 weeks after the operation. Complications of surgery include injury to the sensory branch of the superficial radial nerve, neuroma formation and complex periodic pain syndrome.