De Quervain’s tenosynovitis is a condition that impairs the tendons controlling the thumb, in particular the abductor pollicis longus and the extensor pollicis brevis. It involves entrapment of these tendons affecting the first dorsal compartment of the wrist or the area behind the thumb side of the wrist.
With this condition, thickening and degeneration of the tendon sheaths around the abductor pollicis longus and extensor pollicis brevis develop where the tendons pass in through the fibro-osseous tunnel located along the radial styloid at the distal wrist affecting the first dorsal compartment of the wrist or the area behind the thumb side of the wrist.
Patients presenting with this condition will have impaired function of their thumb in the 3 main planes of movement of the thumb; abduction, extension and opposition.
De Quervain’s injury normally affects adults who use repetitive wrist or hand motions in their daily activities, and typically affects women more than men.
Frequently Asked Questions
What is De Quervain tenosynovitis?
De Quervains tenosynovitis is a condition that affects the tendons controlling the thumb; abductor pollicis longus and the extensor pollicis brevis. Thickening and degeneration of the tendon sheaths will develop where the tendons pass through the fibro-osseous tunnel located near the radial styloid, causing increased friction and compression of these tendons.
This kind of injury is associated with repetitive hand, wrist or thumb movements and patients will normally present with pain near the back of the thumb or just below, impaired function of thumb movements and/or swelling in that area.
How does De Quervain’s tenosynovitis typically occur?
De Quervain’s tenosynovitis occurs when the tendons on the thumb side of the wrist become irritated or inflamed, causing pain and swelling. This condition typically arises from repetitive movements or overuse, particularly those that involve gripping, pinching, or twisting motions. It can also result from direct injury or trauma to the wrist. The two tendons affected in De Quervain’s tenosynovitis pass through a narrow tunnel on the thumb side of the wrist, and when they become inflamed, they struggle to move freely, leading to pain and restricted motion. Other factors, such as hormonal changes during pregnancy or underlying conditions like rheumatoid arthritis, can also contribute to the development of the condition.
Someone who has injured the scapholunate ligament has usually had a fall onto their hand landing on a dorsally extended and ulnar deviated hand. Pain is reported to be dorsal-radial and there is an inability to weight-bear in wrist extension. With palpation, there is tenderness over the ligament.
What are the symptoms of De Quervain’s tenosynovitis?
De Quervain’s tenosynovitis is characterized by several key symptoms, primarily pain and swelling on the thumb side of the wrist. The pain often worsens with activities that involve gripping, pinching, or twisting, such as opening jars or texting. Individuals may also experience tenderness along the tendons of the wrist and thumb, particularly when pressing on the area or moving the thumb. Another hallmark symptom is swelling, which can make the wrist and thumb appear puffy. In some cases, a creaking or snapping sensation, known as crepitus, may be felt when moving the affected tendons. As the condition progresses, individuals might notice a decrease in grip strength and difficulty performing everyday tasks that require fine motor skills. If left untreated, De Quervain’s tenosynovitis can lead to chronic pain and limited mobility in the wrist and thumb. Early diagnosis and intervention are key to managing these symptoms effectively.
How do you diagnose De Quervain’s tenosynovitis?
A physiotherapist can diagnose De Quervain’s tenosynovitis using special tests, typically Finkelstein, Eichhoff and WHAT tests.
- The Finkelstein test involves holding the patient’s thumb firmly with one hand while applying firm traction longitudinally and in the direction of slight ulnar deviation to the wrist with the other hand.
- The Eichhoff test requires the patient to oppose the thumb into the palm and clench the fingers while the examiner passively applies ulnar deviation to the wrist. The Finkelstein and the Eichhoff tests, while effective, can sometimes produce a false-positive due to the stress on other structures throughout the test.
- The WHAT test (wrist hyperflexion and abduction of the thumb) is a highly specific and sensitive test whereby the patient is asked to actively hyperflex their wrist and abduct their thumb while the physiotherapist will apply counter-pressure.
All three tests are provocative and if they elicit pain in the patient, De Quervain’s tenosynovitis is present.
In addition to these tests, diagnostic imaging including ultrasound, x-ray and MRI can show tendon and soft tissue inflammation. Imaging can also be used to rule out differential diagnoses such as fractures or arthritis.
What is the treatment for De Quervain’s tenosynovitis?
De Quervain’s tenosynovitis can be effectively managed conservatively with surgery as a last resort if symptoms fail to resolve with conservative management. Current research tells us that the most effective treatment options are corticosteroid injections, injected near the radial styloid, coupled with hand physiotherapy. Physiotherapy treatments may include soft tissue massage and joint mobilisations, ice to reduce inflammation, and a progressive strengthening program to restore function of the wrist and hand.
Other modalities to manage De Quervain’s tenosynovitis include thumb spica splints and immobilisation. Despite thumb spica sprinting offering temporary pain relief for patients, this treatment option carries a high failure and recurrence rate, which can often be attributed to poor compliance from patients. Splinting may be a viable option for patients with mild cases of De Quervain’s tenosynovitis. Strict immobilisation with a rigid splint or cast may worsen tendon degeneration, making a removable semi-rigid splint a preferable option.