De Quervain’s Disease Fundamentals
De Quervain’s disease is a painful inflammation of specific tendons that extend the thumb. The swollen tendons and their coverings cause friction within the narrow tunnel or sheath through which they pass. The result is pain that may extend from the forearm to the thumb base. De Quervain’s was named after the Swiss surgeon who first described the condition in 1895. It is one of the most common types of tendon lining inflammation (also called tenosynovitis).
What causes De Quervain’s Disease?
Overuse, a direct trauma or injuries to the thumb, repetitive grasping and certain inflammatory conditions, such as rheumatoid arthritis, can all trigger the disease. Gardening, racquet sports, and various workplace tasks are some activities that can aggravate the condition. It is also seen during the last trimester of pregnancy and in mothers of nursing children. Often, its cause is unknown. De Quervain’s affects women eight to 10 times more often than men. People who engage in activities that require sidewise motion of the wrist while gripping with the thumb (e.g., hammering, skiing) may be more likely to develop the condition.
Pain along the back of the thumb, directly over the two thumb tendons – the extensor pollicis longus brevis and the abductor – is typical of de Quervain’s. The condition can occur gradually or suddenly. In either case, the pain may travel into the thumb or forearm. Thumb motion may be difficult and painful, particularly when pinching or grasping objects. Some people also experience swelling and pain on the side of the wrist at the base of the thumb. The pain may increase with thumb and wrist motion. Some people also feel pain if direct pressure is applied to the area.
The test most frequently used to diagnose de Quervain’s disease is the Finkelstein test. Your doctor will ask you to make a fist with your thumb placed in your palm. When the wrist is suddenly bent to the little finger side (as in casting a fishing pole), the swollen tendons are pulled through the tight space. If this maneuver is very painful, it is likely that you have de Quervain’s disease. Arthritis and other forms of tendonitis may also cause symptoms in this area.
What are the benefits of treatment?
The main benefits of treatment are to alleviate the pain associated with the condition and improve mobility and function. Treatment usually involves wearing a splint 24 hours a day for four to six weeks to immobilize the affected area and refraining from any activities that may aggravate the condition. Ice may also be applied to reduce inflammation. If symptoms continue, your doctor may give you anti-inflammatory medication – which may be taken orally or injected – to reduce swelling. If de Quervain’s disease does not respond to conservative medical treatment, surgery may be recommended.
What are the risks and complications of surgery?
Risks include nerve injury, infection, bleeding, stiffness of thumb, recurrence, pain or numbness at the incision.