What Is De Quervain Tendinopathy?
De Quervain tendinopathy means inflammation of tendons in the thumb or wrist. It is also called De Quervain tendinosis or De Quervain tenosynovitis. It is named after the Swiss surgeon Fritz de Quervain who described the condition in 1895. It is characterized by pain and difficulty moving the thumb or grasping anything.
How Is It Caused?
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Tendons connect the muscle to the bone.
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Tendons are surrounded by a sheath which helps in the gliding movement of tendons allowing the thumb to move quickly without any pain.
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Whenever there is inflammation, it is either swelling of the tendon or sheath, preventing the gliding motion of the tendon into the sheath; as a result, there is friction, restricting the movement of the thumb and wrist along with pain.
What Are the Risk Factors of the Condition?
It is caused due to,
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Repetitive Action: Continuous or overuse of the thumb.
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Injury: Trauma to the thumb or wrist.
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Systemic Illness: Inflammatory conditions such as rheumatoid arthritis.
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Age: Individuals in the age group 30 to 50 years.
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Gender: Females are more likely to be affected than males.
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Pregnancy: During pregnancy, there is fluid retention due to hormonal fluctuation, which may lead to inflammation of the tendons triggering the condition.
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Activities: Sports such as tennis, racquetball, and skiing and activities such as gardening and using a hammer allows the continuous usage of thumb and wrist muscles.
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Infant Care: Holding and lifting a child may lead to pressure on the tendon, leading to inflammation and pain.
What Are the Symptoms?
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Pain in thumb or wrist.
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Inability to grasp things due to pain.
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Swelling of the thumbs or wrist.
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Numbness of thumb due to irritation of the nerve.
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Radiating pain till the forearm.
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Snapping and sticking sensation of the thumb.
How to Diagnose the Condition?
Examination of the Patient :
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The surgeon will evaluate the patient's medical history to discover any systemic disease.
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Surgeons will evaluate the nature of pain, aggravating and relieving factors, duration of pain, at what time it occurs, how often it occurs in a day, and history of any injury.
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History of medications taken by patients to relieve pain.
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The surgeon will also examine the hand and analyze whether there is pain during applying pressure.
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Finkelstien test: In this test, the patient is asked to hold the wrist in a fist position with the thumb wrapped around the fingers. After this patient is asked to move his fist in an up and downward motion in the form of shaking someone's hands; during this motion, if the patient experiences pain due to swollen tendons, it confirms the condition of De Quervain tendinopathy.
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Once the surgeon completes the evaluation of the patient, he discusses the treatment options available and the precautions to be followed by the patient.
What Are the Treatment Options?
Both non-surgical and surgical methods can treat De Quervain tendinopathy.
Non-Surgical Methods :
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Once the diagnosis is made, the surgeon starts the non-surgical methods, such as
1. Examination of the Patient :
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Avoiding Activities: Extra care should be taken by avoiding activities that may cause pain and swelling.
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Ice treatment: Applying ice on the affected to reduce the inflammation.
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Splinting: Splinting can restrict the movement of the thumb and allow the tendon to heal. They are worn for four to six weeks.
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Medications: Anti-inflammatory medications such as Aspirin, Naproxen, and Ibuprofen are suggested to reduce pain and inflammation. Sometimes steroid injections such as Cortisone help to reduce the signs and symptoms in cases of severe pain and swelling.
Surgical Methods :
The surgical method is preferred once all the non-surgical procedures fail to relieve the patient.
1. Anesthesia :
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Surgery is usually performed under local anesthesia, and patients can return home on the same day, but sometimes, patients may need to be in the hospital overnight.
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In some cases, general anesthesia is preferred depending on the severity of the condition.
2. Incision :
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In this procedure, a transverse incision of 2 centimeters is placed below the thumb cautiously, avoiding injury to nerves and carefully exposing the ligament.
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Once the ligament is reached, the sheath is incised to expose the tendon so it can easily glide over without restriction.
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This procedure allows the tendon to move without causing pain or inflammation.
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The main aim of the surgery is to provide free movement for the thumb and wrist.
3. Post-Operative Care Instructions:
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A simple dressing or bandage is given to prevent infection.
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After the surgery, patients might feel sore for a few days, but eventually, it will heal within two weeks.
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The patient can move his thumb quickly; however, they should avoid excessive stress and holding heavy objects until complete healing is achieved.
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The wound area can be cleaned with mild soap.
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Follow the medications suggested by the doctor.
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Sutures are usually removed within two weeks; in the case of resorbable sutures, patients need not come to the hospital for removal.
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Patients are advised to continue the physiotherapy exercises after healing to improve the flexibility of their thumb and wrist.
4. Complications :
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Infection or inflammation.
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Permanent scarring or bruising.
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Numbness.
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Excessive bleeding.
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Injury to nerves.
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Subluxation of the tendon.
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Allergic reaction to anesthesia.
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Failure of the surgical procedure.
Can This Condition Be Prevented From Recurrence?
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Avoiding painful activities can prevent De Quervain tendinopathy.
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Taking breaks in between and avoiding continuous use of the thumb may help reverse the condition.
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It's crucial to heed your doctor's recommendations regarding what activities would worsen the disease and what you should do. Limiting these behaviors might help with De Quervain's tendinosis in the future.
Conclusion :
De Quervain's tendinosis treatment typically yields excellent results. Many patients do not require surgery. Non-surgical procedures such as medications, splinting, and rest are frequently used in the treatment and tend to improve the condition. Surgery-related cases have a high success rate. De Quervain's tendinosis does, however, require medical attention. If the problem is not treated, it will only get worse with time.
