Also known as De Quervain’s Tenosynovitis, this condition refers to the inflammation of two tendons (extensor pollicis brevis and abductor pollicis longus muscles) that control movement of the thumb along with their tendon sheath. This inflammation causes pain during movement of the wrist and/or thumb. Along with pain, swelling may be present within in the thumb region, as well as radiating pain down into the forearm.
The cause od De Quervain’s Syndrome is poorly understood, although risk factors have been identified. Such risk factors include repetitive movements of the wrist and thumb, trauma, and rheumatic disease. Due to the nature of this disorder, it is more often referred to as a chronic disorder because of the progressive onset. Symptoms of De Quervain’s syndrome often appear gradually over time and include:
Pain and tenderness when moving the thumb.
Swelling near the base of the thumb
Difficulty when moving the thumb in movements such as grasping or pinching
Diagnosing De Quervain’s Syndrome often includes a thorough examination by your health care provider, along with the performance of the Finkelstein Test.
To perform the Finkelstein test, start off by you bend your thumb across the palm of your hand and bend your fingers down over your thumb. Then you bend your wrist toward your little finger. If this causes pain on the thumb side of your wrist, you likely have de Quervain’s tenosynovitis.
Imaging tests are not necessarily needed to diagnose the syndrome. A differential diagnosis of osteoarthritis or intersection syndrome may occur if there is a lack of sufficient evidence to diagnose De Quervain’s Syndrome.
Treatment of this condition relies on both lifestyle modifications as a starting point, if unsuccessful, surgery may be required. Initially immobilization is prescribed to help reduce inflammation along with a cortisone injection. Once inflammation has decreased along with the pain, maintenance of joint range of motion is then prescribed along with exercises to help prevent reoccurrence. If the conservative approach is unsuccessful, surgery to relieve the entrapment by opening the sheath may be warranted. Following the surgical approach, engaging with a physical therapist is recommended to help strengthen surrounding musculature and reduce the chance of any complications that may arise.
