What is De Quervain’s Stenosing Tenosynovitis?
The tendons near the base of the thumb can become inflamed or compressed resulting in De Quervain’s Tenosynovitis. Tendons are thick, rope-like structures that connect bone to muscles to allow movement. The synovium is a thin, slippery layer of soft tissue that covers the tendons allowing then to easily glide through the fibrous tendon sheath. The extensor pollicis brevis and the abductor pollicis longus tendons assist in pulling the thumb away from the palm. As these tendons move into the wrist they pass through a tunnel called the first dorsal compartment. De Quervain’s Tenosynovitis occurs when the lining of this sheath thickens, constricting the tendons.
What causes De Quervain’s Stenosing Tenosynovitis?
As with many disorders of the hand and wrist, De Quervain’s Tenosynovitis is commonly caused by repetitive use, trauma, or any other process that can cause inflammation. De Quervain’s Tenosynovitis is commonly called “Mommy’s thumb” since it is 10 times more common in women, and activities such as lifting gardening pots, groceries, and small children into car seats can inflict symptoms. In recent times this disorder has also been called “Blackberry Thumb” as excessive text messaging is a common culprit.
What are the symptoms of De Quervain’s Stenosing Tenosynovitis?
The primary symptoms are a result of inflammation and include pain, tenderness and swelling of the wrist below the thumb. As the condition progresses movement of the thumb may be reduced affecting grip.
How is De Quervain’s Stenosing Tenosynovitis diagnosed?
In addition to a complete history including activity, onset of pain, and symptoms the physician will also perform a physical examination. The Finkelstein maneuver is frequently used to help diagnose De Quervain’s Tenosynovitis. The thumb is doubled across the palm with the four fingers folded over grasping the thumb. If pain increases when the hand is contracted downward towards the wrist on the little finger side, then the test is considered positive.
How is De Quervain’s Stenosing Tenosynovitis treated?
Initial treatment consists of resting the affected thumb for a period of about four weeks. The thumb and wrist are immobilized in a splint worn continuously, except when showering or washing hands. Ibuprofen or other NSAIDs (non-steroidal anti-inflammatory drugs) may be taken to reduce pain and inflammation. In some cases a one-time cortisone injection may be administered to the first dorsal compartment to alleviate symptoms. Physical therapy and stretching in then used to restore range of motion. Unfortunately 50% of cases require surgical intervention.
In severe cases and those that do not respond to conservative treatment, a minimally invasive surgical release may be indicated. Decompression surgery relieves pressure on the affected tendons. A brace is worn for three days post-operatively, and then physical therapy is initiated. Overall recovery time is about 4-6 weeks.
How can Dr. Knight help you with de Quervain’s Stenosing Tenoysinovitis?
If it is detected that you have de Quervain’s stenosing tenosynovitis, Dr. Knight will follow the standard, conservative treatment regimen, starting with NSAIDs and, if necessary, going as far as a surgery to release the pressure. The primary concern is to relieve your pain and allow you to return to your life and work with full functionality in your hands.
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