The muscles and bones of the hand are connected by thick flexible tissue called tendons. Tendons are covered by a thin soft sheath of tissue known as synovium. Extensor pollicis brevis and abductor pollicis longus are two tendons located on the thumb side of the wrist in the 1st of 6 compartments. Inflammation and swelling of the tendon sheath, puts pressure on the tendon and leads to pain and swelling in the thumb side of the wrist.
This condition is also referred to as De Quervain’s tendonitis, De Quervain’s tendinosis, De Quervain syndrome, or De Quervain’s disease.
Causes
The exact cause of De Quervain’s tenosynovitis is unknown, but is usually seen in individuals with repetitive hand or wrist movements, injury to the wrist or tendon, and inflammatory conditions such as rheumatoid arthritis and inflammatory arthritis. De Quervain’s tenosynovitis is more common in pregnant and middle-aged women.
Signs and Symptoms
The symptoms of De Quervain’s tenosynovitis include pain and tenderness on the side of the wrist at the base of the thumb. You may also have a little swelling and redness in the area. Your symptoms may get worse while making a fist, grasping or gripping things, or turning the wrist. You may experience a “catching” or “snapping” sensation while moving your thumb.
Diagnosis
De Quervain’s tenosynovitis can be confirmed through the Finkelstein test. For this test, you will be asked to make a fist with your fingers covering the thumb and bend the wrist towards the little finger. Pain during this movement will confirm the condition. Sometimes inflammation of skin nerves in the wrist can mimic De Quervains disease. Sometimes swelling of the tendons of the 2nd compartment on the back of the hand (Intersection syndrome) can also be mistaken for De Quervains disease.
Treatment
Treatment of De Quervain’s syndrome consists of both non-surgical and surgical therapy.
Non-surgical therapy includes avoiding activities that increase pain and swelling, using a splint to support and immobilise the hand, and physiotherapy. Anti-inflammatory drugs are helpful in relieving pain and swelling. Dr Bala may also recommend a corticosteroid injection to reduce the swelling of the tendon sheath.
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Surgical therapy: The need for surgery is based on the severity of the pain and response to non-surgical treatment. This outpatient surgical procedure called De Quervains release involves opening or cutting the inflamed part of the tendon sheath to relieve the pressure on the tendon and allow free movement of the wrist. The inflamed synovium would also be removed. Dr Bala ensures that the sheath of the tendon underneath is also freed. Care must be taken while operating in this region to prevent injury to small nerves supplying the skin. Dr Bala uses special magnification loupes to visualize and protect structures in this region to minimize complications.
After the surgical procedure, a dressing is required. Dr Bala will also instruct you on exercises to strengthen your wrist. Dr Bala has undergone cadaver workshops for ultrasound guided and minimally invasive De Quervains release procedures.
Dr Bala also deals with complications of this surgery such as infection and can give you a second opinion if you haven’t gotten better from surgery elsewhere.
