What is De Quervain's (De Quervain's tenosynovitis)?

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, leading to restricted movement and pain. The condition is often mislabeled as "tendonitis," but it is actually a degenerative condition that should be labeled as "tendinosus" or "tendinopathy" 1. The diagnosis of De Quervain's tenosynovitis requires a thorough physical examination, including inspection, range-of-motion testing, palpation for tenderness, and examination maneuvers that simulate tendon loading and reproduce pain 1. Some key features of the condition include:

• Gradually increasing load-related localized pain coinciding with increased activity
• Swelling, asymmetry, and erythema of involved tendons
• Tenderness to palpation
• Pain with tendon loading and movement

Treatment typically begins with conservative measures, including:

• Relative rest of the affected area
• Icing
• Eccentric strengthening exercises
• Topical and systemic nonsteroidal anti-inflammatory drugs for acute pain relief 1
• Corticosteroid injections into the tendon sheath provide significant relief in about 70% of cases. For severe or persistent cases not responding to conservative treatment after 4-6 months, surgical release of the tendon sheath may be necessary, which is an effective treatment option in carefully selected patients 1. It is essential to modify activities that aggravate symptoms to aid in recovery and prevent recurrence. De Quervain's tenosynovitis commonly affects new mothers, people who perform repetitive hand movements, and those between 30-50 years of age.

From the Research

Definition and Description of De Quervain's Tenosynovitis

• De Quervain's tenosynovitis is defined as stenosing tenosynovitis of the synovial sheath of tendons of abductor pollicis longus and extensor pollicis brevis in the first compartment of the wrist due to repetitive use 2.
• It is a common inflammatory condition that is often treated conservatively, characterized by wrist pain and impaired function of the wrist and hand 3.
• De Quervain's tenosynovitis is typically caused by repetitive movements and consequent overload of the tendons, leading to pain symptoms on the radial side of the wrist 4.

Clinical Aspects and Diagnostic Techniques

• Patients with De Quervain's tenosynovitis usually present with pain symptoms on the radial side of the wrist, and the condition is easily distinguishable from other wrist injuries during physical examination 4.
• The Finkelstein test is often used to diagnose De Quervain's tenosynovitis, which involves bending the thumb into the palm, making a fist with the fingers over the thumb, and then bending the wrist toward the little finger 2.
• Early recognition of De Quervain's tenosynovitis is crucial for treatment decisions, as it is very well treatable, especially in the acute phase 4.

Treatment Options

• Conservative management, including splinting and local corticosteroid injections, is often the first line of treatment for De Quervain's tenosynovitis 3.
• Platelet-rich plasma (PRP) injections have also been shown to be a promising and safe alternative to conventional steroid injections in the treatment of De Quervain's tenosynovitis 5, 6.
• Surgical intervention is usually not necessary, but may be considered in cases where conservative management is not effective 4.
• Local corticosteroid injections have been shown to be effective in reducing pain and improving function in patients with De Quervain's tenosynovitis, with benefits sustained for up to 12 months 3.