de Quervain’s Tenosynovitis

de Quervain’s tenosynovitis is from chronic friction between the two tendons in the thumb and the sheath they share. de Quervain’s is the most recognized type of stenosing tenosynovitis. The thumb motion is restricted by the swollen tendons. Jobs with a high rate of de Quervain’s include buffers/grinders, sewers and cutters, packers, and housekeepers.

Anatomy

Pain on the side of the wrist and forearm just above the thumb may be DeQuervain’s Tenosynovitis. Two tendons of the muscles that pull the thumb out and back from the hand (abductor pollicis longus and extensor pollicis longus) run in a tunnel on the side of the wrist above the thumb. These tendons pass through a common tunnel in the forearm that is lined with a slippery coating, tenosynovium. This slippery substance helps limit friction as the tendons glide back and forth moving the thumb. Inflammation of the tenosynovium and tendon is called tenosynovitis.

Causes

Problems arise when the tendons are unable to glide within the tunnel. Repeatedly performing activities like grasping, pinching, squeezing, or wringing may lead to a tenosynovitis. This irritation can lead to swelling, which further hampers the smooth gliding action of the tendons within the tunnel. Injury or rheumatoid arthritis can also lead to a tenosynovitis in this area.

Symptoms

At first, the only sign of trouble may be soreness on the thumb side of the forearm. If the problem isn’t treated, pain may spread up the forearm or down into the wrist and thumb. Due to an increase in friction, the two tendons may actually begin to squeak as they attempt to move through the constricted tunnel. This noise is called crepitus.

Diagnosis

The diagnosis of DeQuervain’s Tenosynovitis is usually easily made on the physical
examination. Usually no fancy tests are required. The major problem can be distinguishing the DeQuervain’s Tenosynovitis from Intersection Syndrome (Tenosynovitis at the Wrist), which is very similar. Careful attention must be paid to where the pain is located – over DeQuervain’s Tunnel or over the Intersection point.

The Finklestein Test is used to make the diagnosis. Bend your thumb into the palm and grasp the thumb with the fingers. Now bend your wrist away from your thumb. Pain over the tendons to the thumb suggests the problem may be DeQuervain’s Tenosynovitis.

Prevention/Treatments

Take frequent breaks or limit the amount of time you are performing tasks that require
repetitive wringing, grasping, turning and twisting type movements of the wrist. Keeping the wrist in a neutral alignment may help prevent this syndrome. A brace or splint on the wrist and thumb may be used for short term relief to rest the area and quiet the inflammation.

Anti-inflammatory medications, (such as ibuprofen, aspirin, and naprosyn) are commonly prescribed to try and quiet the inflammation in the tendons and synovium. An injection of cortisone into the tunnel will usually control the inflammation in the early stages of the process, but may be temporary.

Finally, if all else fails, surgical release of the roof of the tunnel to give the tendons more space may be necessary. This surgery usually is done as an outpatient, and can be done with a local anesthetic (numbing the area with lidocaine) or a regional anesthetic (putting the whole arm to sleep).

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