De Quervain Disease (De Quervains Tenosynovitis)

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What is De Quervain Disease (De Quervains Tenosynovitis)

De Quervain disease is inflammation of the tendon on the thumb side of the wrist. Tendons are cords of tissue that connect bones to muscles. The tendons in your hand pass through a tunnel, or sheath.

A slippery layer of tissue (synovium) lets the tendons move smoothly in the sheath. With de Quervain disease, the sheath swells or thickens, causing friction and pain.

De Quervain Disease is also called de Quervain Tenosynovitis and de Quervain syndrome. It occurs most often in women who are 30–50 years old.

Tendons attach muscles to bones. They also help with joint movements. When tendons become irritated or swollen, it is called tendinitis.

The extensor pollicis brevis (EPB) tendon connects the EPB muscle to a bone that is near the base of the thumb. The EPB muscle helps to straighten and extend the thumb.

De Quervain disease is a stenosing tenosynovitis of the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons, which lie in the first extensor compartment at the level of the wrist.

De Quervain tenosynovitis is a condition in which the EPB tendon lining (sheath) becomes irritated, thickened, and swollen. This condition is sometimes called stenosing tenosynovitis. This condition causes pain on the thumb side of the back of the wrist.

De Quervain’s tenosynovitis occurs when the 2 tendons around the base of your thumb become swollen. The swelling causes the sheaths (casings) covering the tendons to become inflamed. This puts pressure on nearby nerves, causing pain and numbness.

What are the causes of De Quervain disease ?

The exact cause of de Quervain disease is not known. It may result from:

  • Overusing your hands, especially with repetitive motions that involve twisting your hand or using a forceful grip.
  • Pregnancy.
  • Rheumatoid disease.
  • Activities that repeatedly cause your thumb and wrist to extend.
  • A sudden increase in activity or change in activity that affects your wrist.

What increases the risk of De Quervain disease?

You may have a greater risk for de Quervain disease if you:

  • People who are over 40 years of age.
  • You are pregnant. The hormonal changes that occur during pregnancy can cause de Quervain’s tenosynovitis.
  • Have rheumatoid arthritis.
  • Use your hands far more than normal, especially with a tight grip or excessive twisting. People who do activities that involve repeated hand and wrist motions, such as tennis, racquetball, volleyball, gardening, and taking care of children.
  • Females.
  • People who have diabetes.
  • Women who have recently given birth.
  • People who do heavy labor.
  • People who have poor wrist strength and flexibility.
  • People who do not warm up properly before activities.

What are the symptoms of De Quervain Disease?

Pain on the thumb side of your wrist is the main symptom of de Quervain disease. Other signs and symptoms include:

  • Pain that gets worse when you grasp something or turn your wrist or when you straighten your thumb or extend your thumb or wrist .
  • Pain that extends up the forearm.
  • Pain when the injured area is touched.
  • A fluid-filled cyst in the affected area, which may or may not bulge through your skin.
  • Numbness along the back of your thumb and index finger
  • Swelling of your wrist and hand.
  • A sensation of snapping in the wrist.
  • A “catching” or “snapping” feeling when you move your thumb
  • A squeaking sound as the tendons move within the swollen sheaths
  • Trouble moving the thumb and wrist, Decreased thumb motion due to pain.
  • Pain or tenderness over the thumb side of the back of the wrist when your thumb and wrist are not moving.

How de Quervain disease is diagnosed?

De Quervain Disease is diagnosed with a medical history and physical exam. Your health care provider will ask for details about your injury and ask about your symptoms.

Your health care provider may diagnose de Quervain disease based on your signs and symptoms. A physical exam will also be done.

A simple test (Finkelstein test) that involves pulling your thumb and wrist to see if this causes pain can help determine whether you have the condition. First, you bend your thumb so it rests across your palm. Then you make a fist, closing your fingers over your thumb. Last, you bend your wrist toward your little finger. If you have tenderness or pain at the base of your thumb, you probably have dDe Quervain Disease.

Sometimes you may need to have an X-ray.

MRI features of de Quervain disease

In its early stages, De Quervain Disease is seen on T2-weighted images as distention of the tendon sheath surrounding both tendons by high signal intensity fluid in the region of the distal radius. Increased signal intensity may be seen in the tendons due to the development of associated tendon degeneration. In later stages, the fluid-filled tendon sheath is replaced by surrounding low signal intensity scar tissue that encases the two tendons.

Prevention

How to prevent de Quervain disease?

Avoiding repetitive movements is the most important way to prevent De Quervain Disease. Change your actions to reduce the stress on your wrists, and take frequent breaks to rest. Wear a brace or splint on your thumb and wrist, if necessary.

Follow the exercise routine suggested by your doctor or physical therapist. Be sure to tell him or her about any activities that cause pain, numbness or swelling.

How is this treated?

Treatment may include the use of icing and medicines to reduce pain and swelling. You may also be advised to wear a splint or brace to limit your thumb and wrist motion.

In less severe cases, treatment may also include working with a physical therapist to strengthen your wrist and calm the irritation around your EPB tendon sheath. In severe cases, surgery may be needed.

Your doctor may recommend injections of steroids or a local anesthetic (numbing medicine) into the tendon sheath to help reduce swelling and pain.

A physical therapist or occupational therapist can show you how to reduce stress on your wrist by changing how you move. He or she can also teach you exercises to strengthen your muscles. Most people notice improvement in 4 to 6 weeks and are able to use their hands and wrists without pain once the swelling is gone.

It is important to treat de Quervain’s tenosynovitis. If this condition isn’t treated, it can permanently limit your movement or cause the tendon sheath to burst.

  • Using a splint 24 hours a day for 4 to 6 weeks to rest your thumb and wrist.
  • Applying heat or ice to the affected area.
  • Taking a nonsteroidal anti-inflammatory drug (also called NSAIDs), such as ibuprofen (two brand names: Advil, Motrin) or naproxen (one brand name: Aleve).
  • Avoiding activities that cause pain and swelling, especially those that involve repetitive hand and wrist motions.

Questions to Ask Your Doctor

  • What is the likely cause of my pain?
  • What is the best treatment option for me?
  • How long before I can expect relief from my symptoms?
  • When can I return to my activity (job, sport, etc.)?
  • Is it possible that my symptoms could return?
  • What kind of exercises should I do to strengthen my thumb?

Avoiding any activity that causes pain and swelling is the best treatment. Other options include:

  • Wearing a splint.
  • Taking medicine. Anti-inflammatory medicines and corticosteroid injections may reduce inflammation and relieve pain.
  • Having surgery if other treatments do not work.

Follow these instructions at home:

Managing pain, stiffness, and swelling

  • If directed, apply ice to the injured area.
    • Put ice in a plastic bag.
    • Place a towel between your skin and the bag.
    • Leave the ice on for 20 minutes, 2–3 times per day.
  • Move your fingers often to avoid stiffness and to lessen swelling.
  • Raise (elevate) the injured area above the level of your heart while you are sitting or lying down.
  • Take medicines only as directed by your health care provider.

If you have a splint or brace:

  • Wear it as told by your health care provider. Remove it only as told by your health care provider.
  • Loosen the splint or brace if your fingers become numb and tingle, or if they turn cold and blue.
  • Keep the splint or brace clean and dry.

General instructions

  • Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • Keep all follow-up visits as told by your health care provider. This is important.
  • Do not drive or operate heavy machinery while taking prescription pain medicine.

Contact a health care provider if:

  • Your pain medicine does not help.
  • Your pain, tenderness, or swelling gets worse, even if you have had treatment.
  • You develop new symptoms.
  • You have numbness or tingling in your wrist, hand, or fingers on the injured side.

De Quervain Disease Surgical Release

Will I need surgery for de Quervain’s tenosynovitis?

You might need surgery if your case is severe or if other treatments don’t relieve your pain. During outpatient surgery, the surgeon makes a small cut in the sheath around the swollen tendons. This provides more room for the tendons to move.

After surgery, you will need to do physical therapy to strengthen your wrist and thumb, and to prevent the problem from coming back. Once the area has healed and returned to full strength, you should have normal use of your hand.

De Quervain tenosynovitis surgical release is a procedure to relieve inflammation and pain in the thumb and wrist caused by de Quervain tenosynovitis. This is a condition in which the lining (sheath) around a cord of tissue in the wrist (extensor pollicis brevis tendon, or EPB tendon) becomes irritated, thickened, and swollen. This causes pain on the thumb side of the back of the wrist.

During this procedure, the sheath around the EPB tendon will be cut (released). This relieves pressure on the tendon. The goal of the procedure is to relieve pain and inflammation, and to improve range of motion of the thumb and wrist.

Tell a health care provider about:

  • Any allergies you have.
  • All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
  • Any problems you or family members have had with anesthetic medicines.
  • Any blood disorders you have, including any history of blood clots.
  • Any surgeries you have had.
  • Any medical conditions you have.
  • Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

  • Infection.
  • Bleeding.
  • Allergic reactions to medicines.
  • Damage to other structures or organs, such as nerves in the hand or wrist (rare).
  • A return of pain or stiffness in the thumb.

Ask your health care provider about:

  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood.Do not take these medicines before your procedure if your health care provider instructs you not to.
  • Do not use any tobacco products—such as cigarettes, chewing tobacco, and e-cigarettes—for at least 1 day before your procedure. If you need help quitting, ask your health care provider.
  • You may have a physical exam.
  • You may have tests, including X-rays of your hand and wrist.
  • You may have a blood or urine sample taken.
  • Follow instructions from your health care provider about eating or drinking restrictions.
  • Plan to have someone take you home after the procedure.

What happens during the procedure?

  • To reduce your risk of infection:
    • Your health care team will wash or sanitize their hands.
    • Your skin will be washed with soap.
  • An IV tube will be inserted into one of your veins.
  • You will be given one or more of the following:
    • A medicine to help you relax (sedative).
    • A medicine to numb the area (local anesthetic).
    • A medicine that is injected into an area of your body to numb everything below the injection site (regional anesthetic).
  • An incision will be made in your wrist.
  • An incision will be made in the sheath that covers the EPB tendon, and the sheath will be opened.
  • If you have any fluid-filled sacs (cysts) or other inflamed tissues, they will be removed.
  • The incision will be closed with stitches (sutures) and covered with a bandage (dressing).
  • A splint or brace will be put on your wrist and thumb area to keep it from moving.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

  • Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored often until the medicines you were given have worn off.
  • You will have a splint or brace on your wrist and thumb area.
  • You will have some pain. Medicines will be available to help you.
  • Do notdrive for 24 hours if you received a sedative.

Care After De Quervain Disease Surgical Release

These instructions provide you with information about caring for yourself after your procedure. Your health care provider may also give you more specific instructions.

Your treatment has been planned according to current medical practices, but problems sometimes occur. Call your health care provider if you have any problems or questions after your procedure.

What can I expect after the procedure?

After the procedure, it is common to have:

  • Mild pain in your wrist and thumb area.
  • A small amount of blood or clear fluid coming from your incision.

Follow these instructions at home:

If you have a splint or brace:

  • Wear the splint or brace as told by your health care provider. Remove it only as told by your health care provider.
  • Loosen the splint or brace if your fingers tingle, become numb, or turn cold and blue.
  • Do not let your splint or brace get wet if it is not waterproof.
  • Keep the splint or brace clean.

Bathing

  • Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you can take showers. You may only be allowed to take sponge baths for bathing.
  • If your splint or brace is not waterproof, cover it with a watertight covering when you take a bath or a shower.
  • Keep your bandage (dressing) dry until your health care provider says it can be removed.

Incision care

  • Follow instructions from your health care provider about how to take care of your incision. Make sure you:
    • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
    • Change your dressing as told by your health care provider.
    • Leave stitches (sutures) in place. Sutures may need to be in place for 2 weeks or longer.
  • Check your incision area every day for signs of infection. Check for:
    • More redness, swelling, or pain.
    • More fluid or blood.
    • Warmth.
    • Pus or a bad smell.

Managing pain, stiffness, and swelling

  • If directed, put ice on the affected area.
    • Put ice in a plastic bag.
    • Place a towel between your skin and the bag.
    • Leave the ice on for 20 minutes, 2–3 times a day.
  • Move your fingers often to avoid stiffness and to lessen swelling.
  • Raise (elevate) your hand above the level of your heart while you are sitting or lying down.

Driving

  • Ask your health care provider when it is safe for you to drive.
  • Do not drive or operate heavy machinery while taking prescription pain medicine.
  • Do not drive for 24 hours if you received a sedative.

Activity

  • Rest your hand as much as possible while it heals.
  • Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
  • If physical therapy was prescribed, do exercises as told by your health care provider.

General instructions

  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • Do not use any tobacco products, such as cigarettes, chewing tobacco, and e-cigarettes. Tobacco can delay bone healing. If you need help quitting, ask your health care provider.
  • Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

  • You have problems with your splint or brace.
  • Your pain gets worse or does not get better with medicine.
  • You have more redness, swelling, or pain around your incision.
  • You have more fluid or blood coming from your incision.
  • Your incision feels warm to the touch.
  • You have pus or a bad smell coming from your incision.
  • You have a fever.

Get help right away if:

  • You lose feeling in any part of your hand, wrist, or arm.

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