From the Guidelines
De Quervain's tenosynovitis is a painful condition affecting the tendons on the thumb side of the wrist, characterized by inflammation of the abductor pollicis longus and extensor pollicis brevis tendons as they pass through a narrow tunnel in the wrist. This condition is often caused by repetitive hand or wrist movements, making pregnant women, new mothers, and people who frequently perform activities requiring thumb and wrist movements particularly susceptible 1.
Key Characteristics
- The condition occurs when the tendons become inflamed, leading to pain and tenderness on the thumb side of the wrist
- Repetitive hand or wrist movements are a common cause of De Quervain's tenosynovitis
- Modifying activities that aggravate symptoms is essential for recovery and preventing recurrence
Diagnosis and Treatment
Treatment typically begins with conservative measures, including rest, ice, and anti-inflammatory medications, as well as immobilization with a thumb spica splint 1.
- A study by Choi et al. highlighted the importance of identifying anatomic variations in the first extensor compartment, which can aid in diagnosis and treatment [not directly cited, but related to 1].
Important Considerations
- Corticosteroid injections into the tendon sheath are highly effective, with about 70-80% of patients experiencing significant relief after one injection, although the exact protocol may vary depending on the specific clinical context and patient needs.
- Physical therapy focusing on gentle stretching and strengthening exercises can help prevent recurrence, and should be considered as part of a comprehensive treatment plan.
From the Research
Definition and Characteristics of De Quervain's Tenosynovitis
- De Quervain's tenosynovitis is characterized by swelling of muscles (abductor pollicis longus (APL) and extensor pollicis (EPB) brevis) located at the base of the thumb 2.
- It is a painful condition that can cause inflammation and restrict daily routine work due to prolonged ignorance and neglect 2.
- The disorder is triggered by preexisting tendon degeneration induced by excessive twisting actions and is associated with inflammatory arthritis 2.
Causes and Risk Factors
- De Quervain's tenosynovitis can be caused by repetitive wrist ulnar deviation with thumb abduction and extension 3.
- Patients who undergo high-torque wrist turning or other repetitive everyday movements, such as handshaking, have a higher risk of developing tenosynovitis 2.
- The disease can also occur without any visible prior trauma or injury 2.
Diagnosis and Treatment
- Clinical evaluation is usually required for diagnosis, and imaging studies may be used to confirm the diagnosis or check for alternate diseases 2.
- Treatment options include nonsteroidal anti-inflammatory medication (NSAIDs), physical therapy, immobilization with splints, and rest 2.
- Corticosteroid injections or surgery may be considered in situations that do not respond to preventive treatment 2, 4.
- A systematic review and meta-analysis found that corticosteroid injection is more effective than immobilization for De Quervain's tenosynovitis, and combining the two treatments provides additional benefit 4.
Treatment Outcomes and Management
- Studies have shown that corticosteroid injections can provide complete relief of pain in patients with De Quervain's tenosynovitis 5, 4.
- Immobilization following injection may not contribute to improved patient outcomes and may hinder activities of daily living 3.
- A case study demonstrated the effectiveness of conservative care, including anti-inflammatory medication, corticosteroid injections, and occupational therapy, in managing De Quervain's tenosynovitis 6.
- Surgery may be considered in cases where conservative care is not effective, and can provide relief from prolonged pain 2, 6.