De Quervain’s Tenosynovitis

Briefly

De Quervain’s Tendonitis or de Quervain Tenosynovitis is an inflammation of the tendons at the first dorsal compartment of the wrist. The main cause of the inflammation is the excessive use of the thumb. The main symptom is wrist pain, in the extension of the thumb.

What is De Quervain’s Tenosynovitis

The Swiss surgeon Fritz de Quervain was the first to describe the inflammation of the tendons of the first dorsal compartment of the wrist, in 1895. In particular, the exact scientific term is: “De Quervain stenotic Tenosynovitis”. However, the disease is known for brevity’s sake as “De Quervain tendonitis”. Inside this relatively narrow space are located two tendons, responsible for the movement of the thumb: Extensor pollicis longus and abductor pollicis longus.

Normally, tendons move without problem and perform their function. However, in case of excessive use or acute injury, edema (swelling) and inflammation are caused in the area. As a result, tendons are pressed and their normal movement is prevented.

De Quervain’s Tendonitis is also known as the “housewife’s thumb” because women are affected about 8 times more often than men. The usual age of onset is after the age of 40.

Fig. 1: Pain localization

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De Quervain’s Tenosynovitis: What are the Symptoms?

Pain in the extension of the thumb in the wrist area is the characteristic symptom of De Quervain tendonitis. It worsens when trying to hold objects or making rotational movements. During the exacerbation of the disease, when inflammation is intense, every simple movement of the thumb is painful and the patient is unable to perform even simple daily activities. In advanced stages of de Quervain tendonitis, tendons may be blocked during their motion or even being completely immobile due to edema. If symptoms are not treated, can last for weeks or months. Usually they occur after a period of excessive use of the thumb.

Fig. 2: Inflammation of the tendons

De Quervain’s Tenosynovitis: Causes and risk factors

The cause of tendonitis is the overuse of the thumb with movements of extension, flexion and rotation. A classic example is new mothers, who hold their baby in their arms for many hours and both tendons are under constant pressure, causing them to become inflamed and swollen. De Quervain tendonitis is even more common in almost all manual professions and nurses. In many cases, of course, the exact cause cannot be determined.

 De Quervain’s Tenosynovitis: Diagnosis

For the diagnosis of de Quervain tendonitis, the proper history taking and a detailed clinical examination are usually sufficient. The pain is very easily detected by putting pressure just above the tendons in the wrist, while there may be obvious swelling in the area due to edema.

In addition, there is a characteristic test (Finkelstein-Test) where the thumb is pressed towards the palm. If severe pain occurs, then de Quervain’s Tenosynovitis is almost certain.
Radiological examination for de Quervain’s Tenosynovitis is usually not necessary. Only if there is a need to rule out other causes regarding the origin of the pain, an X-ray or MRI scan is required.

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De Quervain’s Tenosynovitis: Treatment

De Quervain’s Tenosynovitis is initially treated conservatively. In the early stages where the symptoms are not so severe, it is recommended to rest, avoid activities that aggravate the problem and take anti-inflammatory drugs for a short period of time.

It is even helpful to place a thumb splint. Topical use of cortisone in de Quervain tendonitis should be done with extreme caution and only by orthopedic specialists, because the risk of nerve injury in the area is high.

When the symptoms persist, then surgery is necessary. The operation is performed under local anesthesia and requires a small incision (2cm) just above the tendons in the wrist area. The patient leaves the hospital the same day, can move his arm immediately after the operation and in 2 weeks can return to normal activities. If the surgery is performed by a specialized upper limb orthopedic surgeon, tendonitis does not appear again.

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