De Quervain’s Disease
De Quervain's disease is a painful inflammation of tendons at the base of the thumb that extend to the wrist. The swollen tendons and their coverings rub against the narrow tunnel through which they pass, causing a tenosynovitis. This results in pain at the base of the thumb and extends into the lower arm.
What are the Causes?
The cause of de Quervain's disease is often unknown. However, overuse, a direct blow to the thumb, repetitive grasping and certain inflammatory conditions such as rheumatoid arthritis can all trigger the disease. Various occupational tasks, racquet sports, and gardening may also aggravate the condition.
Who is Affected?
While anyone can get de Quervain's, it affects middle-aged women eight to 10 times more often than men.
What are the Symptoms?
The most common symptom of de Quervain’s is pain along the back of the thumb, directly over two thumb tendons. The onset can occur gradually or suddenly; and the pain may radiate from the thumb up into the forearm.The pain is usually worse when using the hand and thumb. It is most noticeable with forceful grasping, pinching of objects or twisting of the wrist. A "catching" or "snapping" sensation may be felt with movement of the thumb. Some people may feel pain if direct pressure is applied to the area; others may experience numbness.
What Testing is Available?
The test most frequently used to diagnose de Quervain's disease is the Finkelstein test. The test involves making a fist with the thumb placed in the palm. When the wrist is bent toward the outside, the swollen tendons are pulled through the tight space and stretched. If this movement is painful, de Quervain's disease may be a possibility.
What are Treatment Options?
Splints may be used to rest the thumb and wrist 24/7 for a few weeks.Anti-inflammatory medication (NSAIDs). These medications can be taken by mouth or injected into that tendon compartment. They may help reduce the swelling and relieve the pain.Avoiding activities that cause pain and swelling. This may allow the symptoms to resolve on their own.Corticosteroids. Injection of corticosteroids into the tendon sheath may help reduce swelling and pain.
Surgical release of the tight covering of the tendon eliminates the friction that causes inflammation, restoring the tendons' smooth gliding capability.
A recommended exercise program to strengthen the thumb and wrist post-surgery improves healing. Recovery times vary depending on age, general health, and how long the symptoms have been present. In patients whose disease has developed gradually, de Quervain's is usually more resistant to treatment. For those patients, it may take longer to find relief.