De Quervain's tenosynovitis

What is De Quervain’s Tenosynovitis?

De Quervain’s disease is essentially a stenotic tenosynovitis of two of the thumb’s tendons.

Athletes, manual workers, and people who systematically deal with computers often have problems with tendons in their hands.

In general, people who use their hands in repetitive and dynamic activities belong to the high-risk group who develop De Quervain’s tenosynovitis.

 

Anatomy

De Quervain’s tenosynovitis affects the abductor pollicis longus tendon and the extensor pollicis brevis tendon of the thumb.

These tendons are embedded in a bundle of connective tissue creating a channel through which they slide to accomplish their purpose.

Repeated thumb movements create inflammatory conditions to its tendons and their surrounding sheaths.

This inflammation can lead to local edema, which has a direct effect on the difficulty of the tendons’ movements in their canal. This causes pain on the base of the thumb, which is often so strong that the patient has to stop working.

Patients with rheumatoid arthritis often develop the disease, while in other cases an injury to the thumb tendons can create scarring that obstructs the normal functioning of the tendons.

Two of the thumb tendons are inflamed so they cannot easily slip into their sheath causing intense pain (blue = normal texture and thickness of the tendon sheaths, red = tendons and their sheaths are in an inflammatory state).

The edema caused to the tendons sheaths impedes their painless movement.

 

What are the symptoms?

Patients usually complain of pain at the base of the thumb that worsens during wrist movements.

Edema can be observed in acute conditions at the base of the thumb.

Difficulty to perform thumb extension and abduction is also reported, due to mechanical obstruction.

 

How is it diagnosed?

The diagnosis of De Quervain’s tenosynovitis is essentially clinical. The orthopedist examines the patient and essentially sets the diagnosis. Radiological examinations are performed to rule out other diseases such as arthritis of the wrist, which has a completely different treatment.

 

Test: A. The patient grasps the thumb in his/her palm.

 

Test: B. The patient turns the wrist to the opposite direction.

 

The reproduction of pain during this test is an indicative but not a diagnostic test for the condition.

 

How do you deal with De Quervain’s tenosynovitis?

The main goal in the treatment of De Quervain’s tenosynovitis is to relieve the pain caused by irritation and local edema.

 

Splint: The use of a splint can provide relief from the severe symptoms as it stabilizes the thumb and wrist joint.

 

Anti-inflammatory medication. Anti-inflammatory medicines taken orally or intramuscularly relieve pain and inflammation. However, long-term use is not recommended.

 

Avoid activities that cause pain and edema. This fact alone can permanently eliminate the symptoms.

 

Cortisone. Topical injection of cortisone into the sheath that covers the tendons helps reduce edema and pain. But the overuse of cortisone has no indication.

 

How is De Quervain’s tenosynovitis treated surgically?

If conservative treatment does not relieve the patient’s pain and dysfunction, surgery will provide definitive treatment.

 

On the day of the surgery:

The patient visits the clinic for short term hospitalization, fasting.

 

The duration of the surgery is 15-20 minutes and is performed under local anesthesia.

 

The purpose of the surgery is to release the tendons from their sheath so they can function normally without friction that creates the vicious cycle of inflammation. The skin is stitched using a special plastic surgery technique for the best possible aesthetic effect. The suture used is bio-absorbable and does not require removal.

 

At the end of the surgery, the wrist and hand are covered with a special cotton band and a rubber bandage and placed in suspension.

 

Postoperatively the patient receives antibiotic and anti-inflammatory treatment for 3 days. The healing process of the surgical wound is monitored at regular intervals.