De Quervain’s Tenosynovitis (Thumb Tendonitis)
It is an inflammation of tendon and tendon’s sheath, which reveals itself with a pain and swelling expanding on the thumb side of the wrist and the base of the thumb in the forearm. The tendons (abductor pollicis longus) that move and take the thumb away from the other fingers, and the tendons (extensor pollicis brevis) that bend it backwards, pass through a tunnel in the wrist, which is near the base of the thumb. Thickening and stiffness that occur in the tunnel as well as swelling of the tendon sheaths constricts the sliding movement of the tendons within the tunnel during the movements of the thumb. This condition that reveals itself with pain and wrist tenderness is named after the Swiss surgeon (Fritz de Quervain), who described it for the first time.
What are Its Causes?
Repetitive activities such as gripping, pressing, squeezing, twisting, and typing cause the tendons of these two muscles to jam in the channel, through which they pass. These movements lead to abrasion, degeneration and inflammation in the tendon and tendons sheaths. Inflammation and resultant swelling occur in the synovial tissue that surrounds the tendon. Thus, slippage and movement of the tendon in its sheath becomes difficult.
Similar symptoms may also develop at the beginning or in the course of certain inflammatory rheumatisms such as rheumatoid arthritis and gout. Especially the hand position used by new mothers when they carry their babies; and the effects of hormonal fluctuations in pregnancy and breastfeeding period facilitates the development of this condition. De Quervain’s Tenosynovitis may also be encountered due to wrist fractures and traumas experienced in the past, and after weight training performed with unusual weights.
What are Its Clinical Findings?
Pain in the thumb side of the wrist is the most typical symptom. The pain usually radiates down the thumb or up the forearm. The pain increases during strong gripping movements that involve the use of the thumb, and when twisting the wrist. Swelling may be observed in the painful area of the wrist, as well.
How is it Diagnosed?
With a special test called ‘Finkelstein’s test’, the thumb is bent inside the other fingers. The wrist is bent towards the side of the thumb, in such a way as to provoke it. Pain is typical for diagnosis.
How is it Treated?
In the early period, it is of great importance to let the hand rest by using splinters, which deactivate the painful movements of the thumb. In the same period, non-steroid anti-inflammatory drugs can reduce the swelling of the tunnel and the tendon sheaths. If the symptoms do not get better or if they get worse, the tunnel squeezing the tendons should be surgically opened. Surgery can be performed by local only.