de Quervain's Tenosynovitis
Patients with deQuervain's syndrome have painful tendons on the thumb side of the wrist. Tendons are the ropes that the muscle uses to pull the bone. You can see them on the back of your hand when you straighten your fingers. In deQuervain's syndrome, the tunnel (the first extensor compartment; see where the tendons run narrows due to the thickening of the soft tissues that make up the tunnel. Hand and thumb motion cause pain, especially with forceful grasping or twisting.
De Quervain's Tenosynovitis is a painful condition on the thumb side of the wrist. The condition affects several tendons arising from the back of the forearm, which all converge on the side of the wrist and go from there towards the thumb.
The tendons, which can be multiple, go through a very tight tunnel on their way to the thumb and it is here that they become entrapped and painful due to increasing size of the tendon sheath. Any everyday activities of the hand and wrist can cause significant pain and significant problems performing work and activities of daily living.
The cause of de Quervain's is unknown and the changes are in the tunnel containing the tendons and is not really an inflammation but more a thickening of the tissues. It is thought that sudden and repetitive movements can result in de Quervain's as well as hormonal changes and other age related changes. It can also be associated with post pregnancy and in the initial phases following pregnancy rather like carpal tunnel syndrome.
The symptoms are significant pain on the thumb side of the wrist particularly with moving the thumb across the palm and also bringing the wrist towards the ulna bone. Swelling can be present but is not always present and the pain can range from mild to very severe. It is very rarely affecting both wrists, but usually affects one side.
These include a splint to prevent the thumb and the wrist from moving excessively.
Anti-inflammatory agents and analgesics and cortisone injections into the sheath of the tendons, which is performed by a radiologist under ultrasound guidance.
Failure of non-surgical treatment usually over 6 weeks does often lead to surgical treatment. This often requires a general anaesthetic or a local anaesthetic and sedation and can be done as a day case. Typically, the sheath which contains the tendons is opened and any excess tissue around the tendons is removed.
Rehabilitation involves early movement of the thumb and wrist with a hand therapist and usually results in full resolution of symptoms by 4 – 6 weeks.