De Quervain's tenosynovitis refers to inflammation of tendons together with their enclosing sheath on the side of the wrist at the base of the thumb. These tendons, the extensor pollicis brevis and the abductor pollicis longus tendons, help move the thumb a certain way - to extend and to abduct the thumb (hence their names). On their way to the thumb, the tendons passes through a tunnel (the extensor retinaculum) which helps hold the tendons in place. Much like trigger finger, irritation of the tendon causes the lining (synovium) around the tendon to swell, which makes it difficult for the tendons to move and glide into the tunnel. However, unlike trigger finger, there is no 'catching' sensation - just pain at the side of the wrist during certain positions of the hand.
Patients with De Quervain's frequently complain of pain with certain movements of the wrist, for example when pouring tea from a teapot, using a watering can and lifting the grocery bags during shopping. These particular wrist movements will cause a strain on the said tendons - leading to the wrist pain.
The pain can be replicated by bending your thumb inwards into your palm and making a fist - this is the basis of the eponymous Finkelsteins test. (if you can read Thai, here's a DIY video of the test :P)
Here's a picture of the test - it can be quite painful for the patients to perform so I would proceed slowly if I were to conduct the examination.
Patients are commonly women aged 30 to 50, and frequently mothers of infants. Indeed sometimes when the patients of a child bearing age sees me in the clinic for the problem, my usual interview question would include "have you recently had a baby?" Apparently picking up and carrying of the baby puts the wrist in an awkward position, putting strain to the tendon, and hormonal changes in the tissues further aggravates this situation.
Other conditions that may mimic this would include basal thumb arthritis or the intersection syndrome (most commonly confused with)
Treatment is basically conservative. A period of splinting would help to rest the inflamed tissue; there are smaller splints now which are more comfortable to wear, do ask your therapist about it. Non-steroidal anti-inflammatory medications (NSAIDs), ultrasound therapy and ice all help to relieve the inflammation. These conservative means are all that is needed for the majority of patients
Steroid injection directly into the sheath can be given for more severe cases, although there is a risk of discolouration of the skin at the injection site.
Failed conservative management would necessitate a surgical release of the constricting sheath of the tendon ( the 1st dorsal compartment ). This could be done on an outpatient basis, ideally under general anaesthesia.
- the Bomoh Tulang -
references:
| Treatment of de Quervain's disease:role of conservative management. |
| Ilyas AM "de Quervain Tenosynovitis of the Wrist" J. Am. Acad. Ortho. Surg., December 2007; 15: 757 - 764. |
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