What is it?
de Quervain’s tendonitis is a condition brought on by inflammation of the first extensor compartment tendonitis – the first place where the 2 thumb tendons pass.
What causes it?
The inflammation concerns two tendons : the long conductor and the short extensor of the thumb, which are located and slide in their tunnels/sheaths externally stabilized by a tendinous structure called dorsal carpal ligament.
Overburdening of the tendons causes tendonitis inside the tunnels/sheaths which causes swelling of and increased friction between the two tendons and their sheaths and then thickening of the rope-like structure of the extensors making thumb movement limited and painful. The symptoms occur when we perform certain repetitive movements requiring bending and straightening of the thumb.
New mothers, nursing children in their arms, are especially prone to this type of tendonitis. Other movements burdening the thumbs, such as frequent texting or earlier injuries or fractures may cause occurrence of the symptoms of the disease.
Signs and symptoms.
Pain over the thumb-base side of the wrist is the main symptom of the disease.
The pain may appear either suddenly or increase gradually. Pain may radiate down the thumb or travel up the forearm, limiting the hand and thumb motion, which may result in “dropping” objects. Pain may increase when moving the wrist and thumb, especially when grasping objects or twisting the wrist..
A soft swelling or a cyst may appear over a painful spot, suggesting the occurrence of inflammation within the area of the first extensor compartment. Pain is often accompanied by dysaesthesia (tingling, numbness, which is also called paraesthesia by the surgeons) occurring in the dorsal part of the thumb and the index finger, as well as in the hand. Paraesthesia can be triggered off by percussion of the place where the most intensive pain occurs.
Examination and diagnosis
Swelling, pain and dysaesthesia can occur over the course of the first dorsal compartment tentdons at the base of the thumb-base side of the wrist allow to diagnose the disease. Your physician may ask you to perform the Finkelstein test by placing your thumb against your hand, making a fist with your fingers closed over your thumb, and then bending your wrist towards your little finger in order to confirm the existing tendonitis.
The initial therapy may be conservative.
The goal if the treatment is to relieve the pain, swelling, inflammation and dysaesthesia. Your physician may recommend taking anti-inflammatory medication by mouth, locally administered drugs (ointments) and immobilization of the thumb and wrist with orthotics.
Injections (blockades) of corticosteroids into the tendon sheath can also be used to remove the symptoms. In order to relieve or remove the inflammatory condition and symptoms your physician may also recommend physiotherapy/rehabilitation.
Resting of the thumb is often enough to relieve the condition.
If the non-operable treatment is ineffective, a surgery may be recommended involving opening of the compartment to make more room for the inflamed tendons and release the hypertension causing the symptoms of the disease.
A patient can move the thumb and the wrist and perform different everyday actions immediately after the surgery.
Pain usually disappears immediately after the surgery or within a few weeks.
In an advanced stage of the disease, regaining normal feeling in the hand may take even a few months.
After an operation, the surgeon may recommend physiotherapy, but it depends on individual indications,
Your physician will choose the best course of treatment for you.