From the Guidelines
De Quervain's tenosynovitis is a painful condition affecting the tendons on the thumb side of the wrist, characterized by inflammation and swelling of the tendons and their surrounding sheath, leading to pain, swelling, and difficulty moving the thumb and wrist. This condition occurs when the two tendons that control thumb movement, specifically the abductor pollicis longus and extensor pollicis brevis, become inflamed and swollen, causing the surrounding tendon sheath to thicken and become narrow 1. The condition typically develops from repetitive hand or wrist movements, such as gripping, grasping, or pinching objects. Common symptoms include pain near the base of the thumb, swelling at the wrist, difficulty or pain when moving the thumb or wrist, and a "catching" or "stopping" sensation when moving the thumb.
Diagnosis and Treatment
The diagnosis of De Quervain's tenosynovitis can be made using ultrasound (US) or magnetic resonance imaging (MRI), with US being useful for examining extra-articular soft tissues and diagnosing abnormalities of the flexor and extensor tendons and tendon sheaths 1. Treatment usually begins with conservative measures including rest, ice, anti-inflammatory medications, and wearing a thumb spica splint to immobilize the affected area. If these measures don't provide relief, a corticosteroid injection into the tendon sheath may be recommended 1. In persistent cases, surgery might be necessary to release the tight compartment around the tendons.
Key Points
- De Quervain's tenosynovitis is a painful condition affecting the tendons on the thumb side of the wrist
- The condition occurs when the two tendons that control thumb movement become inflamed and swollen
- Common symptoms include pain near the base of the thumb, swelling at the wrist, and difficulty moving the thumb or wrist
- Diagnosis can be made using US or MRI
- Treatment usually begins with conservative measures, with corticosteroid injections or surgery considered in persistent cases 1
From the Research
Definition and Characteristics of De Quervain's Tenosynovitis
- De Quervain's tenosynovitis is a condition characterized by pain and tenderness over the first extensor compartment of the wrist, containing the extensor pollicis brevis (EPB) and abductor pollicis longus (APL) tendons in their individual retinacular sheath 2.
- It is defined as stenosing tenosynovitis of the synovial sheath of tendons of abductor polices longus and extensor pollicis brevis in the first compartment of wrist due to repetitive use 3.
- The condition is more common in women, particularly aged 30-50 years old and those 4-6 weeks in their post-partum period 2.
Symptoms and Diagnosis
- Patients typically present with pain symptoms on the radial side of the wrist as a result of repetitive moments and consequent overload of the tendons 4.
- The condition is easily distinguishable from other wrist injuries during physical examination 4.
- Diagnosis can be made based on clinical presentation, including pain and tenderness over the first extensor compartment of the wrist, and positive Finkelstein test 3.
Treatment Options
- Treatment options include non-operative treatment, such as anti-inflammatory medication, wrist splints, and local steroid injection, as well as operative treatment, such as surgical release of the 1st dorsal compartment 2.
- Conservative management, including eccentric training, can be an effective alternative to current treatment options 5.
- Local steroid injections can lead to significant improvement in patients with De Quervain's tenosynovitis, with 65% of patients being symptom-free after the first injection and 98.75% being symptom-free at 12 weeks 3.