De Quervain's Tendinosis
The muscles and bones of the hand are connected by thick flexible tissue called tendons. Tendons are covered by a thin soft sheath of tissue known as synovium. Extensor pollicis brevis and abductor pollicis longus are two tendons located on the thumb side of the wrist. Inflammation and swelling of the tendon sheaths puts pressure on the tendon and leads to pain and swelling in the thumb side of the wrist.
This condition is also referred to as De Quervain’s tendonitis, De Quervain’s tendinosis, De Quervain syndrome, or De Quervain’s disease.
The exact cause of De Quervain’s tenosynovitis is unknown, but is usually seen in individuals with repetitive hand or wrist movements, injury to the wrist or tendon, and inflammatory conditions such as rheumatoid arthritis and inflammatory arthritis. De Quervain’s tenosynovitis is more common in pregnant and middle age women.
Signs and Symptoms
The symptoms of De Quervain's tenosynovitis include pain and tenderness on the side of the wrist at the base of the thumb. You may also have a little swelling and redness in the area. Your symptoms may get worse while making a fist, grasping or gripping things, or turning the wrist. You may experience a "catching" or "snapping" sensation while moving your thumb.
De Quervain’s tenosynovitis by your history, medical history, and performing a physical examination of the wrist. De Quervain’s tenosynovitis can be confirmed through the Finkelstein test. For this test, you will be asked to make a fist with your fingers covering the thumb and bend the wrist towards the little finger. Pain during this movement will confirm the condition.
Treatment of De Quervain’s syndrome consists of both non-surgical and surgical therapy.
Non-surgical therapy includes avoiding activities that increase pain and swelling, using a splint to support and immobilise the hand, and physiotherapy. Anti-inflammatory drugs are helpful in relieving pain and swelling. Professor Bain may also recommend a corticosteroid injection to reduce the swelling of the tendon sheath.
Surgical therapy: The need for surgery is based on the severity of the pain and response to non-surgical treatment. The outpatient surgical procedure involves opening or cutting the inflamed part of the tendon sheath to relieve the pressure on the tendon and allow free movement of the wrist. The inflamed synovium would also be removed. After the surgical procedure, a dressing is required. Professor Bain will also instruct you on exercises to strengthen your wrist.