Introduction:
A painful disorder that affects the tendons on the thumb side of the wrist is called de Quervain tenosynovitis. When one turns the wrist, grasp something, or make a fist, they most likely experience pain if they have de Quervain tenosynovitis.
While the precise etiology of de Quervain tenosynovitis remains unknown, repetitive hand and wrist movements resulting from gardening, golf, racket sports, or infant lifting can exacerbate the condition.
What Is the Anatomy of de Quervain’s Tendinitis?
Tendons are the connective tissue that connects bone to muscles. It is mainly made up of collagenous (one of the most abundant protein) fibers. Tendons are located all over the body, and they play an important role in the movement of bones as muscles tighten and relax. They also prevent injury to muscles to an extent by absorbing the impact on muscles. Tendons are resistant to tearing. But they are not stretchable. So, if the tendon is strained, it can be easily injured.
Tendons are surrounded by a tunnel of tissue called a sheath. Tendons easily slide through these sheaths and help in the movement of bone according to the contraction and relaxation of the muscle. If there is any inflammation of the tendon or the sheath, the movement can be affected due to friction between the tendon and the sheath. Such a condition is de Quervain's tendinitis. It primarily affects the tendons of the thumbs of the wrist.
De Quervain's tendinitis is one of the most common types of tendon inflammation. It is also known as de Quervain's tenosynovitis or de Quervain's tendinosis. Gamer's thumb, mommy thumb, new mom's syndrome, designer's thumb, texter's thumb, etc., are the common name variants of the condition. It mainly affects women. The exact cause is not yet known. The overuse of the wrist area can lead to this condition. It can be treated medically or surgically, depending on the severity of the disease.
What Are the Causes of de Quervain’s Tendinitis?
The exact cause of de Quervain's tendinitis is not known yet. However, regular use of the wrist may lead to these conditions. Some of the situations that can lead to this condition are;
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A direct blow on the thumb.
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Repetitive grasping.
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Inflammatory conditions like arthritis.
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Playing tennis, golf, or any racquet sport.
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Lifting toddlers.
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Usage of the hammer.
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Gardening.
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Knitting.
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Skiing.
Pregnancy and age groups between 30 years and 50 years can also increase the chances of this condition.
What Are the Symptoms of de Quervain’s Tendinitis?
The main symptom is pain in the thumb side of the wrist. Pain can be acute or chronic, and it may travel up to the forearm. It can aggravate while making a fist, grabbing something, or turning the wrist. The other symptoms include;
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Swelling of the wrist.
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A fluid-filled cyst in the thumb side of the wrist.
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Stiff feel while moving the thumb or wrist.
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Numbness in thumb and index finger.
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Pain aggravates on pinching objects.
When to See a Doctor?
If the condition is treated early, complications can be avoided. If the pain persists after supportive measures like applying ice over the affected area, giving rest to the thumb, over-the-counter painkillers, etc., then it is best to consult a doctor.
How to Diagnose de Quervain’s Tendinitis?
The diagnosis of the condition is made by physical examination and based on the symptoms of the patient. The doctor will check whether it hurts when pressure is applied over the thumb side of the wrist. The doctor will also do a simple test known as the Finkelstein test. It can be easily performed in-office settings or at the bedside. Generally, imaging tests are not required for this condition.
Finkelstein Test:
The patient must sit comfortably and relax on a chair or examination table. The patient holds the affected hand in the air and the other hand resting against their body. Then the patient is asked to bend the thumb across the palm and then bend the other fingers over the thumb, making a fist. Then the wrist is moved up and down (motion while handshaking or bending the wrist towards the little finger). This will stretch the tendon over the sheath. If the tendon is swollen, it can result in pain, indicating a positive for de Quervain's tendinitis.
What Are the Risk Factors?
De Quervain tenosynovitis risk factors include:
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Old Age: De Quervain tenosynovitis is more common in persons between the ages of 30 and 50 than in other age groups, including children.
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Gender Prevalence: In women, the illness is more prevalent.
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Having a Pregnancy: Pregnancy may be linked to the illness.
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Infant Care: Frequently utilizing the thumbs as leverage when lifting a child has been linked to the disorder.
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Repetitive Hand and Wrist Motions in Their Jobs or Hobbies: They could be a factor in de Quervain tenosynovitis.
What Is the Treatment for de Quervain’s Tendinitis?
The primary aim of the treatment is to reduce inflammation, restore movement, and prevent reoccurrence. It can be self-limiting and will resolve without any intervention. In those cases, with proper rest, the symptoms will go away. However, if the symptoms persist, along with rest, medications, splints, exercises, and sometimes surgical treatment (mostly in chronic cases) will be required.
Ice can be kept over the wrist for symptomatic relief for 20 minutes. Do not place it directly over the affected area. It should be wrapped in a cloth. Giving proper rest to the wrist and thumb is very important. Splinting the thumb can also provide temporary relief.
Medical management involves over-the-counter pain relievers like Ibuprofen, Naproxen, etc. The doctor may also recommend injections of corticosteroid medications. Surgical management is required if the symptoms fail to improve after two corticosteroid injections.
Surgical management is performed in an outpatient setting. It involves local, regional, or general anesthesia. A tourniquet is also placed to avoid intraoperative bleeding and identify anatomic structures. Then the incision is given on the skin. The affected sheath is incised to relieve the pressure. After reducing the stress on the tendon, the skin is closed, and a soft dressing is placed. Patients are advised to begin with mild activities after surgery. Usually, within two weeks, patients can resume normal activities. Patients may experience mild discomfort or swelling for a few months after surgery. Mild stretching exercises are recommended for reducing the symptoms.
What Are the Differential Diagnoses for de Quervain’s Tendinitis?
The differential diagnosis of de Quervain's tendinitis includes;
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Gonorrhea.
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Bursitis.
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Felon.
What Are the Complications of de Quervain’s Tendinitis?
If the condition is left untreated, it can make wrist movement difficult. Complications related to surgery can also be there. It includes injury to the nerve in the wrist (superficial radial nerve), muscle entrapment, and partial dislocation of the tendon.
How Can de Quervain’s Tenosynovitis Be Prevented?
Steer clear of repetitive movements to prevent de Quervain's tenosynovitis. Modify the movements to lessen the strain on the wrists. If people are utilizing their wrists, take frequent breaks to rest. If required, place a splint or brace on the wrist and thumb. Adhere to the workout regimen that the physical therapist or doctor has recommended. Make sure one informs them of any actions that result in discomfort, edema, or numbness.
What Is the Prognosis of de Quervain’s Tendinitis?
With nonsurgical or surgical treatment, the majority of patients with De Quervain's tenosynovitis perform extremely well and eventually experience relief of their symptoms. With splints, NSAIDs, and injections, 50-80 % of patients can be successfully treated without surgery. Most of the remaining patients recover nicely from surgery.
Surgical complications are not common. Individuals with diabetes have a higher risk of surgical complications, such as infection and poor wound healing, and may respond less well to injectable therapy.
Conclusion:
De Quervain's tendinitis is a common medical condition. If diagnosed in less than six months, it can be easily cured with proper rest and medical management. If diagnosed after six months, it may require surgical management. The prognosis is excellent after treatment. Episodes of recurrence may occur, but with proper rest and long-term hand rehabilitation exercises, recurrence can be avoided.
