De Quervain’s tenosynovitis
QT Pathologies (EN)
De Quervain's syndrome is a painful condition that affects extensor pollicis brevis (EPB) and abductor pollicis longus (EPL) tendons where they run through a tunnel named 1st extensor compartment on the thumb side of the wrist.
- Tunnel anatomy (green, 1st extensor compartment) and tendons extensor pollicis brevis (EPB) and abductor pollicis longus (EPL) Anatomy images courtesy and copyright of Primal Pictures Ltd – www.primalpictures.com
It appears without obvious cause in many cases.
Mothers of small babies seem particularly prone to it, but whether this is due to hormonal changes after pregnancy or due to lifting the small object repeatedly is not known.
There is little evidence that it is caused by work activities, but the pain can certainly be aggravated by hand use at work, at home, in the garden or at sport.
- Pain on the thumb side of the wrist, as shown in the diagram. Pain is aggravated especially by lifting the thumb, as in the hitchhiker position or when using scissors.
- Tenderness if you press on the site of pain.
- Swelling of the site of pain – compare it with same spot on the opposite wrist.
- Clicking or snapping of the tendons occurs occasionally.
- Sometimes, a disorder of skin sensitivity on the back of the thumb and tingling (paraesthesia) can be felt (irritation of the dorsal cutaneous sensory branch of the radial nerve)
- Topographic anatomy of the region Anatomy images courtesy and copyright of Primal Pictures Ltd – www.primalpictures.com
Finkelstein test is the maneuvre used to diagnose De Quervain tenosynovitis : conducted by making a fist with the fingers closed over the thumb and the wrist is bent toward the little finger.
This test ellicites pain in patient who present with this condition by stretching the first extensor tendons compartiment. Pain and swelling are present over the pain site.
Treatment options are:
- Avoiding activities that cause pain, if possible
- Using a wrist/thumb splint. It needs to immobilize the thumb as well as the wrist.
- Steroid injection (relieves the pain in about 70% of cases). The risks of injection are small, but it very occasionally causes some thinning or colour change in the skin at the site of injection.
- Surgical decompression of the tendon tunnel.
Through a transverse or longitudinal incision, and protecting nerve branches just under the skin, the surgeon widens the tendon tunnel by slitting its roof. The tunnel roof forms again as the split heals, but it is wider and the tendons have sufficient room to move without pain. Pain relief is usually rapid. The scar may be sore for several weeks. Nerve branches beneath the skin may need pulling gently to one side to give access to the tunnel, which occasionally causes temporary numbness on the back of the hand or thumb.
During your consultation, Dr. D'Agostino will discuss the current treatment options and can help you choose the best treatment based on your particular case.