De-Quervain’s Tenosynovitis
De Quervain’s tenosynovitis is a common cause of radial-sided wrist pain; it is considered the 2nd most common tendinopathy entrapment in the wrist after trigger finger and affects 1% of the general population. The condition is characterised by a painful stenosing tenosynovitis affecting the 1st extensor compartment of the wrist, which is made up of the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons. These tendons play a vital role in thumb function; through repetitive motion and overuse, they become thickened and show signs of myxoid degeneration, resulting in local inflammation in the surrounding tendon sheaths. De Quervain Tenosynovitis – StatPearls – NCBI Bookshelf
It is 3x more common in women and typically manifests in 30-50-year-olds. De Quervain Tenosynovitis – StatPearls – NCBI Bookshelf. It is very common in post-partum women with gestational risk factors, including the 1st birth and longer periods of pregnancy (over 40 weeks) Risk Factors Associated With de Quervain Tenosynovitis in Postpartum Women – PubMed. It is also associated with the repeated lifting of infants and, as such, is also commonly seen in childcare workers.
What are the signs and symptoms?
There is localised pain over the radial side of the wrist; this is usually slightly proximal to the radial styloid, though referral into the base of the thumb is common with this disease. There will be localised tenderness over the 1st extensor compartment, and Finkelstein testing is usually provocative. This test involves maximum thumb adduction into the palm coupled with ulnar deviation of the wrist. Finkelstein’s Test Is Superior to Eichhoff’s Test in the Investigation of de Quervain’s Disease – PubMed
The pain is usually worse with thumb movements and with activities requiring a thumb pincer grip, such as wringing out a cloth, opening jars or turning the key in a lock.
How is it diagnosed?
The diagnosis of De Quervain’s tenosynovitis will be made from a combination of your clinical history, examination findings and an ultrasound scan.
Ultrasound can confirm the changes as well as help guide targeted intervention in real time. X-rays are not typically indicated but can be useful for excluding other causes of radial-sided wrist pain, such as thumb osteoarthritis. MRIs can confirm the changes but are not typically requested in the diagnosis of this condition.
How are they treated?
Treatment options are divided into conservative and surgical.
Conservative options:
- Activity modification, ergonomic modifications, +/- analgesia/short course of NSAIDs. These simple interventions can be helpful initially, allowing things to calm down. For tradesmen, fitting their tools with a bigger grip can often reduce the symptoms enough to allow them to continue to work and help with general dexterity and gripping activities. A spica splint can also be helpful to support and unload the 1st extensor compartment of the wrist. The Efficacy of Thumb Spica Casting With or Without Corticosteroid Injection for De Quervain’s Tenosynovitis – PMC
- A local anaesthetic and steroid injection into the 1st extensor compartment tendon sheath typically under ultrasound guidance to confirm accurate location and minimise potential injury to the superficial radial nerve, can be helpful at easing some of the inflammation and pain associated with this condition Corticosteroid injection versus immobilisation for the treatment of De Quervain’s tenosynovitis: A systematic review and meta-analysis – PubMed
Surgical options:
If conservative options mentioned previously do not provide adequate relief or if there is a reoccurrence in symptoms, then surgery is usually definitive.
The surgical procedure involves the release of the extensor retinaculum overlaying the 1st extensor compartment of the wrist to reduce any tendon compression and allow more space for the tendons to glide easily with thumb movements. This can be either through an open or endoscopic incision. The surgery is usually very successful but with a small risk of persistence in symptoms or complications, including injury to the superficial radial nerve and localised scar hypertrophy Surgical Treatment Outcome of de Quervain’s Disease: A Systematic Review and Meta-analysis – PMC
Book An Initial Consultation Online
Expert specialist care.
