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What is De Quervain’s Tenosynovitis?
DeQuervain’s Tenosynovitis is an overuse injury involving the tendons surrounding the thumb and wrist. This is characterized by repeated motions in the wrist and thumb, leading to inflammation of the synovium (covering) surrounding the tendons of abductor pollicis longus (APL) and extensor pollicis brevis (EPB).
Who is most at risk for developing De Quervain’s?
Women between the ages of 30 and 50, especially those who have repetitive hand or wrist motions in their daily lives. However, it is also seen in populations that utilize hand tools for extended periods of time such as construction workers or mechanics. (Fakoya) This condition can also be considered acute due to blunt force trauma or biomechanical compression. (Allbrook)
How do you know if you have De Quervain’s Tenosynovitis? (Signs/Symptoms)
Patients typically present with lateral sided wrist pain that may radiate up the forearm. Swelling and tenderness are also noted along the tendons of APL and EPB. Patient’s report their pain typically increases with thumb movement, grasping objects, or twisting of the wrist.
How is De Quervain’s Tenosynovitis diagnosed?
Physicians will guide you through a series of movements including the Finkelstein’s maneuver which involves flexing the thumb across the palm while the physician moves your wrist into ulnar deviation. This is tested on both hands to avoid any false positive findings. (Allbrook)
Ultrasound is another great alternative to diagnose De Quervain’s Tenosynovitis. While providing real-time images of the area, it allows the physician to further view the surrounding tissue structures to evaluate the tendon sheath covering both the APL and EPB tendons.
How can you prevent this?
While there is not much to be done regarding the prevention of the injury, there are ways to prevent further damage once pain begins. Utilizing splints prevent aggravating movements of the wrist and thumb that lead to stenosis- or narrowing- of the dorsal compartment, therefore, allowing rest and recovery to take place. (Allbrook)
What are the treatments of De Quervain’s Tenosynovitis?
Conservative: Surgical intervention is not the typical route of treatment for this injury. The usage of oral steroids, corticosteroid injections, splinting, and physical therapy are the gold standards of care for patients impacted by De Quervain’s. Splinting options include off-the-shelf options that you may find in local drug stores as well as custom made orthotics. It has been reported that corticosteroid injection in combination with usage of a splint have better outcomes than with corticosteroid injection alone. (Fakoya)
Surgery: After failed conservative treatment, either physical therapy or corticosteroid injections, within six months of intervention, surgical release is the next step. During this procedure, the physician will go in and release the first dorsal compartment housing the APB and EPL. This allows the tendons to move freely and decrease the friction and irritation to the tendon sheath. (Fayoka) However, there is always the chance that surgery can fail and lead to subluxation of the tendons. This can be avoided by carefully following post-surgical guidelines and restrictions such as splinting and scar management.