DE QUERVAIN’S TENDONITIS

De Quervain’s tendonitis is a condition that results in pain with use of the thumb from irritation of thumb tendons at the wrist. This is particularly noticeable when forming a fist, grasping or gripping something while twisting the wrist such as wringing a pair of wet socks.

ANATOMY

Two of the main tendons that open the thumb away from the palm pass through a tunnel as they wind over the side of the radius bone at the wrist. Tendons are covered by a slippery thin soft-tissue layer, called synovium and normally glide freely in the tunnel formed by the radius bone and an overlying soft but inelastic “sheath”.

Swelling of the tendon lining and/or thickening of the sheath, results in increased friction between the tendons and the bone with certain thumb and wrist movements.

CAUSES

De Quervain’s tendinosis may be caused by excessive and repetitive thumb use such as using a pair of shears or scissors or twisting wires. It is particularly common in mothers who are nursing infants and may be the result of picking and placing the baby back in the crib.

SYMPTOMS

Pain over the thumb side of the wrist is the main symptom. The pain usually appears gradually and can travel up the forearm. The pain is felt with activities that require gripping and twisting.  Swelling may be noticeable and is seen over the thumb side of the wrist. Some people experience “catching” or “snapping” sensation with thumb movement. In severe cases the pain can make it very difficult to move the wrist or use the hand.

HOW IS THE DIAGNOSIS MADE

The diagnosis is made on history and examination findings of tenderness and swelling on the wrist and provocation of pain by bending the wrist away from the thumb with the thumb clasped in the palm.

TREATMENT

Most cases, especially in the early stages respond to rest in a splint with anti-inflammatory medications. A steroid injection into the sheath will also help and may cure the problem.

SURGICAL TREATMENT

Surgery may be recommended if symptoms are severe or do not improve. The goal of surgery is to open the tendon compartment to make more room for the irritated tendons. Surgery is usually performed under local anaesthetic.

Normal use of the hand can usually be resumed a few days after surgery.