Generality
De Quervain's stenosing tenosynovitis is an inflammatory process affecting the synovial sheath of the thumb tendons (long abductor and short extensor).
De Quervain syndrome can induce a series of functional limitations of the hand, especially if certain activities are performed. The determining cause of the affection is to be found in repeated microtraumas, linked above all to professional activity (embroiderers, VDT operators, musicians ...).
The main symptom, associated with De Quervain syndrome, is pain that occurs when making grip movements with the thumbs and inclination movements of the wrist. Sometimes a swelling can be associated along the course of the tendons, which, with the evolution of the disease, become inflamed and undergo progressive wear (tendinosis) due to the narrowing of the canal.
Causes
The causes that determine the onset of De Quervain syndrome can be many:
- individual predisposition;
- repetitive activities involving the flexion-extension movement of the thumb (example: sewing, using the computer mouse or keyboard, playing an instrument, etc.);
- sudden functional overloads;
- rheumatic diseases.
Symptoms
For further information: De Quervain Syndrome Symptoms
The symptoms of De Quervain's syndrome develop progressively and are:
- persistent pain on the outside of the wrist and at the base of the thumb, accentuated by movements involving the area or while firmly grasping an object;
- swelling along the course of the tendons, compact and extremely painful to pressure;
- painful protrusion, more or less accentuated, in correspondence with the thickening of the fibrous canal;
- if treatment for the disease is neglected, pain can spread from the thumb to the forearm.
Diagnosis
The diagnosis of De Quervain's syndrome is fundamentally clinical: the area corresponding to the first carpal canal is swollen and extremely painful to pressure.
For a correct diagnosis, the Finkelstein test is sufficient, in order to record the degree of pain felt by the patient: the maneuver consists in closing the hand in a fist, closing the long fingers around the thumb and flexing the wrist towards the little finger. In fact, in the subject affected by De Quervain syndrome, the movements of the thumb are difficult due to the intense pain, which is acute when the wrist is tilted. Ultrasound allows to accurately highlight the inflammatory alterations of the tendons and their relationship with the walls of the synovial sheath.
Treatment
In the early stages, conservative treatment, such as functional rest or taking anti-inflammatory drugs, can resolve symptoms and is aimed at reducing inflammation. Applying an ice pack to the styloid process of the radius can reduce pain. In the most important cases, administration of corticosteroids by infiltration can be used.
When symptoms are severe and do not improve with conventional therapies, surgical treatment (pulleyotomy) is necessary. The operation consists in opening the sheath, in order to favor the correct sliding of the tendons. The intervention is decisive and the positive effects are immediate, from the functional point of view (optimal recovery is obtained already three or four days after the operation). The prognosis is therefore excellent.
If De Quervain syndrome is neglected and not treated properly, tenosynovitis can progress to rhizoarthrosis (osteoarthritis of the base of the thumb).
