de Quervain disease
de Quervain disease
Description, Causes and Risk Factors:
Alternative Name: de Quervain syndrome, Radial styloid tendovaginitis, congenital clasped thumb, flexor pollicis longus stenosing tendovaginitis, pollex varus, snapping thumb syndrome, stenosing tendinitis of the abductor, tendovaginitis stenosans, tenosynovitis, trigger thumb.
De Quervain disease is a term used to describe a painful disorder affecting the tendons (a nondistensible fibrous cord or band of variable length that is the part of the muscle that connects the fleshy part of muscle with its bony attachment) at the base of the thumb. This is one of the most common kinds of tendon lining inflammatory diseases or tenosynovitis. These tendons are encased in sheaths, or sleeves, through which the tendons slide. The inner wall of the sheaths contains cells that produce a slippery fluid to lubricate the tendons. With repetitive or excessive movements such as hand twisting and forceful gripping, the lubrication system may malfunction. Failure of the lubricating system allows friction to develop between the tendons of the thumb and their common sheath. The repetitive friction accounts for the abnormal thickening and the constriction of the sheath which interferes with the smooth gliding motion of the tendons.
Tendon involve may include Abductor Pollicis Longus (APL) and the Extensor Pollicis Longus (EPL).
Causes May Include:
Overuse is the main problem, especially repetitive motion of the thumb. Examples of repetitive thumb motion include straightening, twisting, punching, forceful gripping, or thumb bending combined with moving the wrist towards the little finger (such as when hammering or lifting a small child). People who engage in repetitive activities requiring sideways motion of the wrist while gripping the thumb, as in hammering, skiing, some assembly line jobs, etc may be predisposed to developing this disorder.
Direct trauma or a ganglion cyst may also be the cause.
Metabolic abnormalities such as diabetes, hyperuricemia, hypothyroidism, pregnancy, and rheumatoid arthritis may also add to the condition.
This inflammation may be caused by anything that changes the shape of the compartment or causes swelling or thickening of the tendons.
Risk Factors May Include:
Women are afflicted with it 8 to 10 times more often than men.
De Quervain's disease occurs most often in individuals between the ages of 30 and 50.
Initial symptoms result in pain at the thumb side ofthe wrist. The pain is worsened with movementsof the thumb and wrist and particularly lifting.Pain is often feltespecially whengrasping object thenturning the objectsuch as openinga doorknob or turningthe ignition key inyour car.
X-rays are usually not revealing but may indicatethe presence or absence of arthritis. This conditionmust be differentiated from arthritis at the base ofthe thumb, which may be a contributing factor.
The major problem can be distinguishing thede Quervain disease from Intersection Syndromewhich is very similar. Careful attention must be paid towhere the pain is located - over de Quervain tunnel orover the intersection point.
The congenital form is diagnosed by an inabilityto straighten the digits even with force.
Tests May Include:
Have the patient fold the thumb into the palm; closethe fingers over it into a fist, then ulnar deviate thewrist. This is known as the Finkelstein's test, andreproduces the pain of de Quervain disease atthe thumb side of the wrist (the extensor pollicisbrevis and abductor pollicis longus tendons.)
Look for carpal tunnel syndrome with Phalen's test.
Treatment Options: Treatment can be conservative or surgical in nature.
NSAID: Anti-inflammatory tablets (ibuprofen, aspirin, and naprosyn) and topical gels can relieve the symptoms but there is no evidence that they speed recovery.
Rest is important to limit aggravating activities as much as possible to allow the problem to settle whatever other treatment is provided.
Splint can be helpful in reducing discomfort, but will only be effective if it passes from above the wrist to the thumb.
Steroid Injection: Injection of the sheath is very effective in relieving the problem. It has general side effects, but it can cause thinning and/or discoloration of the skin on the wrist, particular if repeated. Therefore not more than two injections are recommended. An injection of cortisone into the tunnel will usually control the inflammation in the early stages of the process, but may be temporary.
Surgery: If pain persists despite non-surgical management, the problem can be solved by surgical release of the sheath. Surgical management involves incising the skin, identifying and cutting the diseased tendon sheath under local anesthesia, and applying a compression bandage.
Treatment such as massage, applying ice or heat compresses can help to relieve symptoms.
Preventive Measures: The prevention of de Quervain disease consists of avoiding excessive movements such as hand and wrist twisting, pinching and forceful gripping. Thumb pressure in pushing controls or while typing should also be avoided.
Disclaimer: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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