De Quervain's Tenosynovitis

Background

De Quervain's Tenosynovitis is a condition that affects the tendons of the first dorsal compartment, located near the base of the thumb at the level of the wrist. The inflammation of these tendons and the tendon sheath results in pain on the thumb-side of the wrist.

Causes

The abductor pollicis longus tendon and the extensor pollicis brevis are located in the first dorsal extensor compartment of the wrist. These two extensor tendons are involved in movement of the thumb and glide through the tendon sheath in this compartment. Overuse can result in inflammation around these tendons. This in turn increases friction in the compartment, restricts movement and causes pain.

Symptoms

The symptoms of De Quervain's Tenosynovitis are pain and swelling in the wrist and the base of the thumb, which is worsened by motion. This pain and swelling restricts the motion of the thumb and wrist, resulting in a diminished ability to grasp and pinch objects. This gradual pain and tenderness may get worse and travel up the arm.

Diagnosis & Treatment

An exam called the Finkelstein test helps confirm the diagnosis of De Quervain's Tenosynovitis. An ultrasound study and confirm inflammation in the compartment as well as the presence of an anatomic variant that can predispose to the condition.

The treatment options for De Quervain's Tenosynovitis can involve splinting, occupational therapy, injections, or surgery. Immobilizing the thumb with a splint, using antiinflammatories, and activity modification are first lines of treatment. Corticosteroid injections into the tendon sheath help reduce swelling and are more effective than splinting. If these non-operative treatment options fail to relieve symptoms, a surgical release may be considered. During this operation, the tendon sheath is divided to make more space for the tendons and allow them to glide more easily within the compartment. The release is often completed under local anesthesia in the office via a small incision.