De Quervain Syndrome

What is De Quervain Syndrome?

The narrowing of thumb tendon causes pain in thumb movement is clinically termed as De Quervain Syndrome. The pain extends from thumbs to side of the wrist. The tendon, which is attached to thumb muscle become narrow at the first extensor compartment or tunnel from where the tendon runs down and attached to the wrist muscle. Thickening of soft tissues with tendon is responsible for narrowing of the tendon. The pain intensity increases when during holding something for a period of time or twisting¹.

Fritz de Quervain, a Swiss surgeon first published an article in 1895, in which he described five case histories with symptoms of tenderness, thickening of the dorsal compartment at the wrist. Latter combination of these symptoms is indicated as De Quervain Syndrome².

Symptoms

The following are the symptoms of De Quervain Syndrome.

• The thumb base pain
• Inflammation close to the base of the thumb
• Thumb and wrist movement become difficult
• Difficulties in grasping or holding
• Movement of thumb is not smooth, feeling of “stop-and-go” or “sticking” is generated
• Prolonged grasping or holding aggravate pain symptom ³

Causes

The exact cause bind pain, the primary symptom of De Quervain Syndrome is not yet exactly known. Patients often have a feeling of inflammation, though no scientific data support the inflammatory factor responsible for the development of De Quervain Syndrome. Individual can experience De Quervain Syndrome at any age of life. The most common incidence is seen after women get newly mother. The onset of De Quervain Syndrome after 4 to 6 weeks of childbirth may due to holding the baby during the change of the nappy, but the most probable cause is a hormonal alteration.

Tenosynovitis is another possible cause of De Quervain Syndrome. This condition often associated with rheumatoid arthritis. Tenosynovitis is developed due to two tendons wrapped with the same sheath get irritated during continuous grasping, typing etc.

If any injury provides local damage of the tendon along with the base of the thumb, then it may also turn to De Quervain Syndrome development, as many tendons pass over the wrist, therefore direct injury may irritate the tendons and swelling develop⁶.

The involved tendons are the abductor pollicis long and the extensor pollicis brevis. Both of these tendons are compactly held adjacent to the radial styloid by the overlying extensor retinaculum. Acute or repetitive injury, which can cause thickening of the tendons restrains gliding of the tendons through the sheath. This causes increase efforts during the movement of thumbs, particularly when collective with the radial or ulnar divergence of the wrist. The outcome this causes persisting pain and inflammation².

Diagnosis

The initial diagnosis is started with a physical examination of the affected hand. During the physical examination, the doctor gives pressure to the thumb side of the wrist for examining the pain intensity.

Finkelstein test is also performed. In this test, the patient has to bend thumb across the palm and also bend fingers down over thumb. Then doctor asks for bending of the wrist toward little finger. All these movements if causes pain on the wrist at the side of the thumb, then it indicates the probability of De Quervain Syndrome.

Depending upon the finding of above mentioned physical examination test report doctor orders X-ray or other imaging tests³.

Treatment

There is mainly two different treatment approaches for De Quervain Syndrome are Non-surgical treatment and surgical treatment.

Non-surgical treatment

There are different therapeutic plans which come under non-surgical plan

Relieving pain syndrome

Oral analgesic medications, which are comes under non-steroidal anti-inflammatory drugs like aspirin, ibuprofen is useful in the reduction of pain symptom^4,6.

Steroidal drug Cortisone group of steroidal drugs is injected into the tendon compartment causes altering of disease course. Though the response varies with individual to individual. Steroidal drug injection inside the tendon compartment causes reduction of tenosynovitis, which is beneficial for reduction of disease course^4,6. De Quervain Syndrome Brace

Wearing of a brace helps to restrict movement of thumb and wrist. The wearing of brace helps to strengthen the attached tendon and improves hand mobility. But the selection of brace is crucial to get benefits, therefore it has advised consulting with a doctor for appropriate brace selection. There are different types of braces are available, among them following types are most widely recommended:

Wrist and thumb support

The aim of wearing this type of thumb wrist brace provides support to the hand by stabilizing both thumb and wrist and also lessen the pain from De Quervain Syndrome^4,5.

Wrist brace and thumb spica

Wearing of this brace causes symptomatic reduction of De Quervain Syndrome. The specific design of this brace allows performing different activities, despite supporting and protecting thumb.

Clod pack vinyl strip

This a novel type strip which is attached to the ice pack. This brace can easily wrap around the thumb and provides pain relief and inflammation reduction. Thus this brace can assist in the recovery of De Quervain Syndrome^4,5.

Therapy

Physical and occupational therapies are also recommended for some cases to provide better mobility of the wrist and thumb. Exercise, tips for preventing the symptoms by positioning of thumb during working such as typing, the proper resting positioning of the hand are also included in these therapies^4,6.

SURGERY

If above mentioned non-surgical treatments unable to provide symptomatic betterment or condition become relapsed after finishing therapy or worsen the condition with time progression, then surgery is the only way out to control the De Quervain Syndrome.

The aim of the surgery is to provide more space between the tendons to prevent the friction between them inside the tunnel. The surgical intervention performs to release the covering of the tunnel. This surgery is not a complicated procedure, therefore usually perform under the outpatient department. The surgery usually performs under regional anesthesia and sometimes general anesthesia also used. An axillary block or a wrist block can be possible by injecting anesthetic agent locally. After anesthetizing the site, surgical intervention helps to create more space between the tendons. After 10 to 15 days the stitches are removed, but several months require for complete recovery after surgery. After surgery doctors may recommend some exercise fast recovery⁶.

References

1. DE QUERVAIN SYNDROME; American Society For Surgery of the Hand; http://www.assh.org/handcare/hand-arm-conditions/de-quervain-syndrome
2. Roy A Meals, De Quervain Tenosynovitis; Medscape; http://emedicine.medscape.com/article/1243387-overview#a9
3. De Quervain’s tenosynovitis; Mayo Clinic Staff; http://www.mayoclinic.org/diseases-conditions/de-quervains-tenosynovitis/basics/tests-diagnosis/con-20027238
4. DE QUERVAIN SYNDROME; PT Health; https://www.pthealth.ca/condition/de-quervain-syndrome-treatment/
5. 3 WAYS TO HELP RELIEVE DE QUERVAIN’S PAIN; Better Braces; https://www.betterbraces.com/blog/3-ways-to-help-relieve-de-quervains-pain/
6. DE QUERVAIN’S TENOSYNOVITIS; methodist; http://www.houstonmethodist.org/orthopedics/where-does-it-hurt/wrist/de-quervains-tenosynovitis/