De Quervain Tenosynovitis

De Quervain tenosynovitis is a condition in which there is inflammation of the tendon sheath along with the synovial fluid around it mainly affecting the tendon sheaths of the 1st dorsal compartment of the wrist characterized by degeneration and fibrosis of the tendon sheath.

It mainly affects individuals aged between 30 and 50 years. Women are affected up to six times more than men. The condition mainly affects the dominant hand. The condition is caused secondary to excessive use of the thumb and wrist while performing various activities.

The patients mainly present with pain during the movements of the thumb, wrist, and hands. The condition is diagnosed mainly on the presentation of the symptoms and a simple test called as Finkelstein test.

The condition is temporary and can be treated adequately with anti-inflammatory drugs and corticosteroids. Physiotherapy also helps to make the patient feel comfortable. In some cases where the pain is not suppressed, decompressive surgery is preferred.

De Quervain Tenosynovitis: Causes

The following are the important causes of developing De Quervain tenosynovitis include −

• A direct injury to the wrist or thumb can be caused by falling on the hand or wrist or by repetitive trauma, such as using a hammer or other tool.

• Some inflammatory conditions, such as rheumatoid arthritis or lupus, can increase the risk of developing De Quervain tenosynovitis.

• Overuse of the hands such as repetitive motions with the hands and wrists, such as typing, knitting, playing musical instruments, or using a computer mouse. Overuse of the tendons can cause them to become inflamed and painful.

• Certain anatomical factors, such as a thickening of the tendons or a narrow tunnel where the tendons pass through, can increase the risk of developing De Quervain tenosynovitis.

De Quervain Tenosynovitis: Symptoms

The patient with De Quervain tenosynovitis mainly presents with the following symptoms that include −

• The main complaint of the patient is pain on the radial side of the wrist that is worsened by moving the wrist or thumb. Pain aggravates on grasping and raising objects with the wrist.

• Sometimes the patient presents with visible swelling over the radial styloid below the thumb.

• The tendon sheath of the affected person feels thick and hard.

• Tenderness is most acute at the tip of the radial styloid. Pain on touching the affected is present.

De Quervain Tenosynovitis: Risk Factors

Several factors play an important role in the development of De Quervain tenosynovitis which include −

• People aged between 30 to 50yrs are at risk

• Females are at more risk compared to males

• Women who are pregnant or have recently given birth are at an increased due to hormonal changes that can lead to swelling and inflammation in the tendons.

• Affects the dominant hand as more activities are done by the using dominant hand

• Injury due to overuse such as by repetitive tasks that involve overexertion on of thumb, radial and ulnar deviation of the wrist

• Patient Certain medical conditions, such as diabetes or thyroid disease, or rheumatoid arthritis can increase the risk

• Women during pregnancy are at increased risk

• Activities such as Wringing out wet clothes, Long use of a computer mouse, Use of scissors, and surgical tongs, Texting, and Hammering, Knitting, Lifting heavy objects such as a jug of milk, taking a frying pan off of the stove, or mother lifting a baby out of a crib increases the risk of developing the condition

De Quervain Tenosynovitis: Diagnosis

The diagnosis of the claudication is mainly done based on history and some of the tests may be required for confirmation that includes −

• A history of pain during the movements of the thumb and wrist arises suspicion of the disease.

• Finkelstein test − The Finkelstein test is a test that help to diagnose De Quervain tenosynovitis. In this test, the patient is asked to make a fist with their thumb tucked inside their fingers. Then the patient is asked to bend their wrist towards their little finger. If this causes pain in the thumb side of the wrist, it is a strong indication of De Quervain tenosynovitis.

• Imaging tests − In some cases, imaging tests such as X-rays or ultrasounds may be used to help diagnose De Quervain tenosynovitis. These tests can help to rule out other conditions that may be causing the patient's symptoms, such as arthritis or a bone fracture.

De Quervain Tenosynovitis: Treatment

Your doctor may prescribe a conservative or surgical treatment based on the severity of the condition −

Conservative Treatment

The treatment is based on the severity of the symptoms. Treatment mainly aims at reducing pain and helping the individual to restore routine activities that include −

• Non-Steroidal Anti-inflammatory drugs are required to reduce pain and inflammation. It is used in mild cases where the pain is less

• Corticosteroid injection is required in patients with significant pain with symptoms lasting for more than 3 weeks.

Physiotherapy

Physiotherapy is more effective in these patients helping the patient to reduce the pain and restore pain-free movements. Physiotherapy involves −

• Immobilization of a thumb spica splint is used to restrict thumb movement so that the first dorsal compartment tendons are at rest.

• Cold compression for 10 to 12 minutes over the inflamed area.

• Ultrasonic therapy involves a pulsed mode of 3 MHz for a duration of 5min. Phonophoresis with 10% hydrocortisone is done. Gentle active and passive motion of thumb and wrist encouraged for 5 minutes every hour to prevent joint contractures and adhesions. Strengthening and stretching exercises are advised once the pain has been reduced

Surgical Treatment

Surgical treatment may be required in severe cases where the symptom is not reduced with a conservative treatment.

Decompression Surgery is the technique done in these patients. Once the decompression is done the patient is advised to 1-2 Days of Immobilization within the cast. Active movement of interphalangeal joints such as flexion and extension is recommended. After 48 hours of surgery, dressings are removed then the gentle active motion of the wrist and thumb is advised for the patient

De Quervain Tenosynovitis: Prevention

Some of the measures that can help to prevent De Quervain tenosynovitis include −

• Regular stretching exercises can help to keep the tendons and muscles in the hands and wrists flexible and reduce the risk of developing De Quervain tenosynovitis. Simple exercises such as wrist circles, fist clenches, and thumb stretches can be effective.

• Avoid repetitive motions while performing repetitive motions with their hands and wrists.

• When performing tasks that require hand and wrist movements, it is important to use proper techniques to reduce the risk of injury.

• Maintaining proper ergonomics when the individual performs repetitive tasks such as adjusting the height of the keyboard and monitor, using a comfortable and supportive chair and taking frequent breaks to stretch and rest the hands and wrists.

• Eating a healthy balanced diet, getting enough rest, and exercising regularly will help to reduce the risk.

Conclusion

De Quervain tenosynovitis is an inflammatory condition that is characterized by the inflammation of the tendon sheaths and the synovial fluid covering the tendon sheaths of the 1st dorsal compartment of the wrist making the person feel pain during the movements of the thumb and wrist affecting the regular activities requiring the thumb and wrist. The condition is confirmed by the Finkelstein test.

It is a mild condition that is not life-threatening. It can be treated adequately with NSAIDs, corticosteroids, and physiotherapy. In patients where conservative treatment is not effective, decompression surgery is recommended.