De Quervain's Tenosynovitis: An Overview
Definition: De Quervain’s tenosynovitis is a painful condition affecting the tendons on the thumb side of the wrist. It involves inflammation of the sheath (synovium) that surrounds two tendons responsible for moving the thumb, specifically the abductor pollicis longus (APL) and extensor pollicis brevis (EPB).
Pathophysiology: The inflammation in De Quervain’s tenosynovitis leads to swelling of the tendon sheath, which restricts the smooth gliding of the tendons. This causes pain, especially during thumb and wrist movements. The condition often results from repetitive activities that strain the wrist and thumb, leading to microtrauma and subsequent inflammatory responses.
Causes:
- Repetitive thumb motions such as pinching, grasping, or wringing.
- Activities involving excessive wrist movements (e.g., gardening, playing racquet sports).
- Acute trauma to the wrist or thumb.
- Inflammatory conditions such as rheumatoid arthritis.
- Hormonal changes, particularly in pregnant and postpartum women.
Symptoms: - Pain and tenderness along the thumb side of the wrist, which may radiate into the thumb or forearm.
- Swelling and possible thickening of the skin over the affected area.
- Difficulty and pain with thumb and wrist movements, particularly when grasping or pinching.
- A sticking or stop-and-go sensation in the thumb with movement.
Diagnosis:
- Clinical Evaluation:
- Physical examination to assess pain, swelling, and tenderness.
- Observation of thumb and wrist movements to identify functional impairments.
- Finkelstein’s Test:
- Patient makes a fist with the thumb tucked inside the fingers.
- The examiner gently moves the wrist towards the little finger (ulnar deviation).
- A positive test is indicated by pain along the thumb side of the wrist, confirming De Quervain’s tenosynovitis.
Treatment of De Quervain’s Tenosynovitis
1. Rest and Activity Modification:
- Rest: Avoid activities that exacerbate symptoms to allow the inflamed tendons and sheath to heal.
- Activity Modification: Modify activities to reduce repetitive thumb and wrist movements and minimize strain.
2. Splinting:
- Thumb Spica Splint: Immobilizes the thumb and wrist to limit movement and reduce inflammation.
3. Medications:
- NSAIDs (Nonsteroidal Anti-Inflammatory Drugs): Reduce pain and inflammation (e.g., ibuprofen, naproxen).
- Corticosteroid Injections: Provide longer-lasting relief by reducing severe inflammation directly within the tendon sheath.
4. Physical Therapy:
- Exercises: Stretching and strengthening exercises to improve the function of the thumb and wrist tendons.
- Manual Therapy: Techniques such as soft tissue mobilization and manual therapy to relieve tension and improve circulation in the affected area.
- Ergonomic Education: Guidance on proper techniques for daily tasks to avoid excessive strain on the wrist and thumb.
5. Ice and Heat Therapy:
- Ice: Apply ice packs to the affected area for 15-20 minutes several times a day to reduce swelling and pain.
- Heat: Use heat packs or warm baths to relax muscles and improve blood flow once the acute inflammation has subsided.
6. Surgery:
- Indication: Considered for chronic or severe cases unresponsive to other treatments.
- Procedure: Surgical release of the constricted tendon sheath to allow the tendons to glide smoothly.
Prevention
- Ergonomic Adjustments: Use proper techniques and equipment to reduce strain on the wrist and thumb.
- Regular Breaks: Take frequent breaks during activities that involve repetitive thumb and wrist movements.
- Strengthening Exercises: Maintain strength and flexibility in the muscles and tendons of the hand and wrist.
Summary
De Quervain’s tenosynovitis is an inflammatory condition affecting the tendons on the thumb side of the wrist, causing pain and functional limitations. Effective management includes rest, activity modification, splinting, medications, physical therapy, and, in severe cases, surgery. Preventative measures can help reduce the risk of developing this condition, promoting long-term hand and wrist health.
