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What is De Quervain's Disease?
De Quervain's disease is a condition that affects the tendons in the anatomical snuffbox area. It is a form of inflammation of the tendons that run along the wrist on the thumb side and attach to the base of the thumb. The inflammation affects the long thumb extensor muscle and the short thumb extensor muscle. These are the two main tendons that help the thumb move away from the index finger and the thumb straighten. These tendons are components of the muscles of the forearm, restricting the so-called anatomical snuffbox. Colloquially, the ailment is known as "the disease of young mothers" who often carry a newborn baby.
Inflammation of the tendon sheaths can cause pain and tenderness along the wrist on the thumb side. It is especially felt when: moving the thumb, folding the hand into a fist, grasping something, rotating the wrist or lifting something with the hands in front of you and thumbs pointing upward. The condition is named after Swiss surgeon Fritz de Quervain, who first described it in 1895.
De Quervain's disease - causes
De Quervain's disease most often occurs in people aged 40-50 years. It is much more common in women than in men. The cause is assumed to be chronic trauma and tendon overload associated with the performance of certain repetitive activities. As a result of cumulative micro-injuries, inflammation of the tendon sheaths of the first compartment occurs, resulting in pain. The cause of impaired tendon gliding can sometimes be bone lesions of the distal root of the radius bone.De Quervain's disease occurs in young mothers, and it is associated with frequent repetitive lifting movements of children.
The main cause of de Quervain's disease is the summation of overload and microtrauma to the tendons of the thumb muscles. People suffering from rheumatoid arthritis may be more susceptible to tendon sheath inflammation.
De Quervain's disease - symptoms
- the main symptom of De Quervain's disease is pain at the base of the thumb and wrist on the same side,
- pain in the area of the styloid process of the radius bone occurring with thumb movements or strong grasping,
- subjective sensation of muscle weakness, dexterity and mobility of the hand,
- painful jumping of tendons and pressure soreness of this area,
- tendons are tense, the sheath is significantly thickened,
- there may be swelling of the wrist on the thumb side, sometimes accompanied by a fluid-filled cyst.
De Quervain's disease - diagnosis
The basis for the diagnosis of De Quervain's disease is the patient's history and examination. During the examination, the painful area, swelling, range of motion of the thumb are evaluated, and dedicated orthopedic tests are performed. One of the tests indicating the presence of De Quervain's disease is the Finkelstein test, which involves clenching the thumb in a fist and flexing the wrist toward the little finger. The patient's report of increased pain during ulnar deviation movement of the wrist confirms the diagnosis.
Orthopedic tests provoke pain by performing activities that irritate the inflamed area. Usually X-rays are not helpful in confirming the diagnosis, but they can rule out other pathologies, such as degenerative changes of the carpometacarpal joint or bone fractures. Due to the superficial location and soft-tissue nature of the altered structures, ultrasound evaluation is a helpful additional test.
Treatment of De Quervain's disease
We begin the treatment of De Quervain's disease with non-operative management, which consists of offloading the affected hand, bracing the limb in an orthosis and, if necessary, administering topical corticosteroids (known as blocks). Bracing is usually carried out in a wrist orthosis, which covers and stiffens the thumb while keeping the interphalangeal joint and fingers II- V free.
- wrist bracing
- administration of non-steroidal anti-inflammatory drugs orally
- steroid injection
- activity modification
De Quervain's disease - surgical treatment
De Quervain's disease can resolve spontaneously and without surgical intervention. In advanced and refractory lesions to conservative treatment, surgery becomes necessary, This is done in a one-day system. The main action during the operation is to cut the trochlea and release the inflamed tendon sheaths. The sensory branch of the radial nerve runs through this area, which the operator must watch out for. Treatment may include local, regional or general anesthesia. Complications after surgical treatment of De Quervain's disease are extremely rare.
De Quervain's Disease - exercises
Five basic exercises for De Quervain's Disease to use at home have been prepared by Rehasport physiotherapist Mateusz Szymański, M.D., M.Sc.
Exercise 1 - Stretching the thumb
Lay your hand with your fingers outstretched on the table, then, bending your thumb and finger 5, touch them with your phalanges together. You may feel a stretch at the base of the thumb. Hold this position for 15-30 sec, repeating this 10 times.
Exercise 2 - Thumb stretch.
Support your forearm and the distal phalanx of your 5th finger against, for example, a table. Grasp the upper surface of the phalanx of the distal phalanx of the thumb, the movement during the exercise: bending the thumb perpendicular to the ground. Hold this position for 15-30 sec, repeating it 15 times.
Exercise 3 - Dorsiflexion of the hand.
Support your forearm on the table, holding the dumbbell with an overhand grip. Starting position maximum palmar flexion - as in the first picture, then you strive for maximum dorsiflexion, maintaining the maximum position reached 5 sec, repeating this 15 times.
Exercise 4 - Hammer flexion and extension.
Grasp the dumbbell like a hammer by one end, you support your forearm against the table, and then lift the dumbbell up, pulling your hand off the ground. You hold the hand in the upper position for 15-30 sec, repeating this 15 times.
Exercise 5 - Dorsiflexion with tape resistance.
Grasp the tape with an overhand grip, and hold the other end with your foot. Rest your forearm against your knee, and then point your hand upward in a smooth motion, hold this position for 15-30 sec, repeating this 15 times.
De Quervain's disease - prevention
If you notice the above symptoms in yourself, which may suggest De Quervain's syndrome, appropriate orthopedic evaluation and further treatment under the supervision of a doctor and physiotherapist is advisable.
Related articles:
Learn about other possible hand and wrist injuries.
Bibliography:
- National Library of Medicine - De Quervain Tenosynovitis - Ellen Satteson; Shruti C. Tannan.
- Ortho Bullets - De Quervain's Tenosynovitis - Evan Watts MD
- Treatment of de Quervain's disease - Arnold-Peter C. Weiss MD, Edward Akelman MD, Mehra Tabatabai MD - The Journal of Hand Surgery Volume 19, Issue 4, July 1994, Pages 595-598
- OrthoInfo - De Quervain's Tenosynovitis - Tyler Steven Pidgeon, MD, FAAOS
