Description

Condition

De Quervain’s tenosynoivitis

Definition / Description

De Quervains Tenosynovitis is a condition where there is irritation or inflammation of the tendons at the base of the thumb. These tendons, which pass across the wrist, run in a sheath which is designed to allow lubrication and gliding with minimal friction. In De Quervains disease the sheath becomes thickened and the tendon no longer runs smoothly, they catch on the sheath and this may be painful.

Populations / Risk Factors

· Problems often occur after prolonged repetitive activity which may irritate the tendons;

· New mothers are prone to developing this problem due to the positions adopted when caring for a baby;

· Hormone changes in pregnancy may also contribute to its occurrence.

Symptoms - (Distribution, description, daily pattern, etc)

1. Pain and swelling over the thumb side of the wrist which may radiate down the thumb or into the forearm. Pain is often worse with gripping and twisting movements.

Clinical Signs - (Reliable measures)

Patients with De Quervain’s tenosynovitis will often complain of pain near the base of the thumb with an associated swelling (secondary to thickening of the tendon sheath). Movements involving grasping or pinching are particularly painful and difficult

On examination, there will be swelling and palpable thickening over the tendon group fibrous sheath. Finkelstein’s test is often positive.

History

Although the exact cause of de Quervain's tenosynovitis isn't known, any activity that relies on repetitive hand or wrist movement — such as working in the garden, playing golf or racket sports, or lifting your baby — can make it worse.

Investigations - (Radiology, haematology etc)

Finkelstein’s test is a simple way of diagnosing DeQuervain’s. It can be performed by placing your thumb in the palm of your hand and making a st around it, then bending your wrist towards your little nger (see picture). If this makes the pain by the base of your thumb worse, the test is considered positive.

If your symptoms don’t get better after treatment, then you may need an ultrasound scan to diagnose the problem.

Atypical Presentations

· Arthritis of Carpometacarpal (CMC) joint – more gradual in onset, usually with a negative Finkelstein’s Test and positive Grind test.

· The Grind test involves forcefully pushing thumb against CMC joint whilst also rotating it slightly, with a positive result producing pain felt on the volar side of the wrist.

· Intersection syndrome – tendons of the first compartment cross over with those of the second compartment, resulting in pain felt over the second compartment.

· Wartenberg’s syndrome – neuritis of the superficial radial nerve, often seen in those wearing tight jewellery.

Management Options and Levels of Evidence

· Rest – it is important to limit the aggravating movements to reduce pain and allow time for the symptoms to settle.

· Splinting – We may recommend that you wear an off the shelf or custom made splint. This can limit the movement of your thumb and helps it to rest.

· Anti-in ammatory painkillers and gels (e.g. ibuprofen) can reduce pain and in ammation.

· A referral to a specialist hand team/consultant/therapist may be required.

· Physiotherapy – If your symptoms do settle, we may then give you some stretching and strengthening exercises to increase your hand function. Your physiotherapist will give you advice and explain what might aggravate your symptoms so you can avoid overusing your hand.

· Steroid injection – If your symptoms are still present after trying physiotherapy, we may recommend that you have an injection of steroid and anaesthetic into the base of your thumb. This will help reduce the swelling and pain.

· Surgery – if the pain persists despite trying the above treatments, the condition may be helped by an operation.

1. Surgery

Surgery is usually done as a day case under a general anaesthetic. The aim of surgery is to open up the tendon sheath and allow the tendons to pass freely and comfortably. Following the surgery the hand will be heavily bandaged for the first few days. After this is removed you can exercise more freely to regain movement in the wrist, fingers and thumb. Stitches are removed in 10 -14 days. This is usually done by making an appointment at your GP practice. You may need to take painkillers and some patients may be referred to physiotherapy if necessary. Your surgeon will advise you.

Useful Resources

https://www.ouh.nhs.uk/patient-guide/leaflets/files/11303Pdequervains.pdf

Clinical pattern sheet for De Quervain’s tenosynoivitis This page is part of the collection 'E-Portfolio 2021'.

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