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De Quervain’s Tenosynovitis

What is it?

De Quervain’s Tenosynovitis was named after a Swiss surgeon, who first described the condition in 1895.  It is an inflammatory condition affecting the two tendons that pass on the thumb side of the wrist to the base of the thumb.  These tendons (namely the abductor pollicis longus and the extensor pollicis brevis) run through a narrow tunnel, which prevents them from slipping off the edge of the wrist as it bends and straightens.  This tunnel is lined with a lubricating sheath (or synovial lining) which helps to lubricate the tendons to allow for their smooth movement.  In patients with De Quervain’s Tenosynovitis, this synovial lining can become inflamed and thickened leading to localised swelling and pain with thumb movements.

Who gets it?

De Quervain’s Tenosynovitis occurs most often in individuals between the age of 30 and 50 years.  It is ten times more common in women, and is often seen four to six weeks after pregnancy.  The specific cause is still not fully understood.

Diagnosis

De Quervain’s Tenosynovitis can often be diagnosed with a detailed history and examination alone.  Tenderness over the tendons and pain on thumb movements is characteristic of the condition.  The surgeon may ask you to place the thumb in the palm and make a fist. Wrist movement towards the little finger side of the wrist may reproduce the pain.  This is called Finkelstein’s test.

Treatment

Initial treatment is often non-surgical, depending on the level of your symptoms.  Treatments may include:

Rest – You may be provided with a splint to rest the wrist and limit the aggravating movements of the tendons through the inflamed sheath.

Anti-inflammatory medication – Either tablets or topical gel can be utilised to help reduce pain and inflammation.

Steroid Injection – Injection into the inflamed sheath can be very effective in relieving symptoms, with 70% of patients deriving benefit.  This is often combined with other measures.

Hand Therapy – The Hand Therapist will undertake techniques such as massage, ultrasound and stretching exercises to encourage normal gliding of the tendons.

Surgery

If the symptoms fail to improve with the above measures and symptoms have been present for some time (more than 3 months), then surgery may be required.

Surgery can be performed under local or general anaesthetic.  A small 2 cm incision is made over the affected tendons and the tight sheath is divided to allow free passage of the tendons.  The stitches are often dissolvable.  A supportive dressing is applied, which aims to allow light hand and finger use.  Sometimes a Plaster of Paris will also be applied.  The dressings will be removed at 10-14 days and you will then be referred to the Hand Therapist to commence an exercise programme.  You may not be able to drive for at least 2 weeks following surgery.  Full recovery should occur by three months.