Microsurgery : De Quervain's Stenosing Tenosynovitis

De Quervain's Stenosing Tenosynovitis

What is it?

Figure 1
Swelling about the tendons to the base of the thumb results in painful motion.

De Quervain's disease is a condition brought on by irritation or swelling of the tendons found along the thumb side of the wrist (Figure 1). The irritation causes the compartment (lining) around the tendon to swell, changing the shape of the compartment or causing the tendon to thicken;this makes it difficult for the tendon to move as it should. The swelling can cause pain and tenderness along the thumb side of the wrist, usually noticed when forming a fist, grasping or gripping things, or turning or twisting the wrist.

What causes it?
A common cause of de Quervain's disease is the swelling of the compartment (lining) of the tendon, know as tenosynovitis.

Signs and symptoms.

Figure 2
Finkelstein maneuver used to diagnose De Quervain's Stenosing Tenosynovitis.

Pain over the thumb side of the wrist is the main symptom. The pain may appear either gradually or suddenly, and it is felt in the wrist and may travel up the forearm. The pain is usually worse with repetitive use of the hand and thumb, especially when forcefully grasping things or twisting the wrist. Swelling over the thumb side of the wrist is noticed and there may be an occasional "catching" or "snapping" when moving the thumb. Because of the pain and swelling, it may be difficult to move the thumb and wrist.

Diagnosis.
A Finkelstein's test is generally performed. In this test, the patient makes a fist with the fingers over the thumb. The wrist is then bent in the direction of the little finger (Figure 2). This test can be quite painful for the person with De Quervain's Stenosing Tenosynovitis.

Treatment.
The goal is to relieve the pain caused by the irritation and swelling. In some cases, your doctor may recommend resting the thumb and wrist by wearing a splint for three to six weeks. Anti-inflammatory medication taken by mouth or injected into that part of the wrist may help reduce the swelling and relieve the pain. In some cases, simply not doing the activities that cause pain and swelling may allow the symptoms to go away on their own.

Figure 3
Surgery opens to compartment over the inflamed tendons.

When symptoms are severe or do not improve, surgery may be recommended. This surgery is generally done on an outpatient basis (where the patient goes home on the same day). The surgery opens the compartment (lining) surrounding the irritated tendons (Figure 3). After surgery, the wrist generally is immobilized by dressing or splint for several days to several weeks followed by exercises to get motion back in the thumb and wrist. Normal use of the hand can usually be resumed once comfort and strength have returned. Your hand surgeon can advise you on the best treatment for your situation.

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