Patients with De Quervain tenosynovitis will present with pulling, burning or aching pain on the thumb side of the wrist that may extend to the arm [7]. Pain will be most obvious when the thumb is in use, especially when extending the thumb or grasping. Worsening of pain usually occurs with recurrent use of the hand, including twisting the wrist, grasping and lifting objects. Upon visual and physical exam, physicians may observe wrist tenderness and swelling (radial side), stiffening and thickening of the 1st dorsal compartment, diminished range of motion of the thumb, crepitus of the APL and EPB and weakness and tingling of the hand [8]. Patients with De Quervain tenosynovitis will have positive Finkelstein’s diagnostic tests.

• Swelling

  The word "tendinosis" refers to a swelling of the tendons. Swelling of the tendons, and the tendon sheath, can cause pain and tenderness along the thumb side of the wrist. [orthoinfo.aaos.org]

  Non-surgical therapy includes avoiding activities that increase pain and swelling, applying ice, using a splint to support and immobilize the hand, and physical therapy. Anti-inflammatory drugs are helpful in relieving pain and swelling. [romanomd.com]

• Inflammation

  When this inflammation becomes chronic, De Quervain’s tenosynovitis may be diagnosed. See Carpal Tunnel Syndrome vs. [sports-health.com]

  Modalities such as electrotherapy and cold laser therapy will be used to reduce inflammation and pain. [healthfitchiro.com]

  De Quervain's Tenosynovitis Treatment Cortisone Injection Cortisone injections can be used to treat the inflammation of small areas of the body (local injections), or they can be used to treat inflammation that is widespread throughout the body (systemic [medicinenet.com]

  Finkelstein’s test What is De Quervain’s tenosynovitis De Quervain’s tenosynovitis Tenosynovitis is simply the inflammation of the sheath that surrounds a tendon (connects muscle to bone). Tendonitis is inflammation of the actual tendon itself. [sportsinjuryclinic.net]

  After treatment and resolution of inflammation, patients typically regain complete function of their thumb and wrist. [symptoma.com]

• Weakness

  Some of the symptoms you may experience include: Weak grip Swelling in the wrist Tenderness on side of wrist Snapping or catching feeling in back of thumb Pain when making a fist or moving thumb and wrist Creaking or squeaking sound when tendons move [mercy.com]

  Weakness in the hand. A “sticking” or “stop-and-go” sensation in your thumb when trying to move it. DIAGNOSIS De Quervain’s Tenosynovitis can be detected by making a fist then moving the wrist down in the direction of the little finger. [gchandtherapy.com]

  […] populations include Massage therapists Musicians Milliners Gardeners Office workers Pregnant and postpartum women Forearm pain Crepitus of tendons within the extensor sheath Unilateral palmer pain and swelling Tendon friction rub Upper-extremity pain Weak [accessphysiotherapy.mhmedical.com]

  Weakness usually accompanies both diagnoses, so when appropriate, strengthening programs are utilized. Both CTS and de Quervains’ tenosynovitis responds well to modalities such as heat or cold. [chautauquapt.com]

  Typical symptoms include: Pain, often radiating to the forearm Aching Burning Weakness Numbness Tenderness There is a special test for De Quervain’s tenosynovitis called Finkelstein’s test. [zerotofinals.com]

• Arm Pain

  There are both surgical and non-surgical options for treating De Quervain tenosynovitis which aim to diminish the wrist and arm pain due to inflammation and distension. [symptoma.com]

  […] at the thumb base Pain may radiate up the arm Pain may occur gradually or suddenly Pain tends to increase with thumb movement Difficulty or inability to grip objects Impaired thumb function affecting daily activities Causes and Risk Factors The cause [trivalleyorthopedics.com]

  […] at the thumb base Pain may radiate up the arm Pain may occur gradually or suddenly Pain tends to increase with thumb movement Difficulty or inability to grip objects Impaired thumb function affecting daily activities Causes and risk factors The cause [kidbones.net]

• Severe Pain

  Progression to a strengthening program once pain and inflammation is reduced Cortisone Injection Strong evidence supports those with moderate to severe pain benefiting from cortisone injection and splinting Surgical Management Surgery is rare and is usually [gchandtherapy.com]

  Inflammation or injury to this area can cause severe pain with wrist motion, especially radial or ulnar deviation. To treat De Quervain’s, usually one or more treatment modalities is helpful. [dentonhand.com]

  If you have severe pain in your wrist when attempting to hold or grasp anything, or make a fist, you may be suffering from De Quervain’s tenosynovitis. If your work or favorite hobby requires repetitive use of your hands, you may be at risk. [msspc.org]

  The test is positive if gentle passive ulnar deviation of the wrist provokes severe pain at the affected tendon sheaths. [msdmanuals.com]

• Arthritis

  Pain When Typing — Is It Carpal Tunnel or Arthritis? Carpal tunnel syndrome and arthritis both affect the feeling and function in your hand. [mdorthospecialists.com]

  […] and inflammatory arthritis. [romanomd.com]

  Causes The exact cause of De Quervain’s tenosynovitis is unknown, but is usually seen in individuals with repetitive hand or wrist movements, injury to the wrist or tendon, and inflammatory conditions such as rheumatoid arthritis and inflammatory arthritis [atlantaorthopaedicinstitute.com]

  Causes The exact cause of De Quervain's tenosynovitis is unknown, but is usually seen in individuals with repetitive hand or wrist movements, injury to the wrist or tendon, and inflammatory conditions such as rheumatoid arthritis and inflammatory arthritis [ahearne.co.uk]

• Wrist Pain

  When treating patients with de Quervain’s Tenosynovitis, they may complain of a swollen thumb and radial-sided wrist pain. [3pointproducts.com]

  Bone scanning appears to be of value in the differential diagnosis of dorsolateral wrist pain when clinical findings are nondiagnostic. [ncbi.nlm.nih.gov]

  […] heavy objects Chronic illnesses such as rheumatoid arthritis and diabetes Pregnancy Symptoms of De Quervain Tenosynovitis Common signs and symptoms of de Quervain tenosynovitis include: Wrist pain on the thumb side Thumb and wrist pain with twisting [uofmhealth.org]

  Topic Images Snapshot A 26-year-old new mother presents to her primary care physician for right wrist pain. She gave birth to a healthy newborn boy 3 months ago who is doing well. She reports pain localized to the radial side of her right wrist. [step1.medbullets.com]

• Tendon Friction Rub

  […] within the extensor sheath Unilateral palmer pain and swelling Tendon friction rub Upper-extremity pain Weak thumb abduction Decreased grip strength Wrist pain and swelling Decreased abduction ROM of the carpometacarpal (CMC) joint, thumb Pain with thumb [accessphysiotherapy.mhmedical.com]

• Tendon Disorder

  Tendon disorders attributed to fluoroquinolones: a study on 42 spontaneous reports in the period 1988 to 1998. Arthritis Rheum. 2001;45(3):235–9. 49. Posthumus M, Collins M, Cook J, Handley CJ, Ribbans WJ, Smith RK, et al. [bmcmusculoskeletdisord.biomedcentral.com]

• Irritability

  De Quervain's tendinosis occurs when the tendons around the base of the thumb are irritated or constricted. The word "tendinosis" refers to a swelling of the tendons. [orthoinfo.aaos.org]

  Why de Quervain’s tenosynovitis develops De Quervain’s tenosynovitis develops as a result of irritation of the tendons at the wrist and lower thumb. Repetitive movement irritates the sheath, or covering, around these tendons. [mdorthospecialists.com]

  The goal will be to contribute to better form and use of other muscle groups, limiting the irritation of the tendons. If you fail to respond to conservative treatment, a consultation for injections and surgery will be recommended. [healthfitchiro.com]

  The primary goal of the treatment is providing relief from the pain caused due to irritation and swelling. There are many options available for managing the symptoms. [drsatishortho.com]

  This nerve objects to being treated roughly (more so than most other nerves in the body) and is easily irritated. [melbournehandsurgery.com]

• Clumsiness

  We report the case of a 14-year-old girl with a history of wrist pain and clumsiness. Magnetic resonance imaging revealed de Quervain tenosynovitis. The patient had a history of using growth hormones for 12 months. [ncbi.nlm.nih.gov]

  This nerve compression causes a decrease in sensation that may result in clumsiness and weakness of the affected hand. Patients may find themselves dropping objects and less capable of performing tasks requiring gripping strength. [ncra.org]

Although radiographs of patients with De Quervain tenosynovitis do not provide enough evidence for a definitive diagnosis, they are recommended to determine whether there is another cause of symptoms, such as carpometacarpal osteoarthritis, fracture and osteomyelitis, which may also causes radial wrist pain. Nonspecific observations that may be found on radiographs include distension of the soft tissue found over the styloid of the radius and the radial styloid may display irregularities, such as scarring, erosion or new bone formation. Ultrasounds, on the other hand, provide useful information that may lead to a diagnosis [9]. De Quervain tenosynovitis is diagnosed using an ultrasound if patients display thickening of the abductor pollicis longus (APL), the extensor pollicis brevis (EPB) and the sheath superficial to the radial styloid, fluid buildup in the compartment housing the APL and EPB, hypoechoic halo sign indicating edema under the skin and/or increased local blood flow. Ultrasounds can also be used to determine whether a septum separating the APL and EPB is present as well as guiding administration of corticosteroids through injection directly into the compartment of the APL and EPB tendons. Magnetic resonance imaging (MRI) will reveal many of the same signs as an ultrasound but it is more sensitive and may detect the earlier mild signs of De Quervain tenosynovitis [10]. If present, MRI will identify debris within the fluid filled sheath of the APL and EPB.

There are both surgical and non-surgical options for treating De Quervain tenosynovitis which aim to diminish the wrist and arm pain due to inflammation and distension. Non-surgical treatments include nonsteroidal anti-inflammatories (NSAIDs), bracing or splinting wrist and thumb for 4-6 weeks, ice, avoiding movements that may aggravate condition and corticosteroid injection within tendon sheath.

Physical therapy may also help patients affected with De Quervain tenosynovitis and disease progression can be monitored with ultrasounds. Clinical studies have demonstrated splinting of the wrist and thumb in combination with NSAIDs leads to an improvement in 57% of patients which is much higher than splinting alone which only led to improvements in 19% of patients [11]. Ultrasound guided corticosteroid injections have shown greater efficacy than manual injections [12]. Low dose steroid injections into the APL/EPB tendon sheath have also shown efficacy in managing the disorder. Up to 93% of patients respond positively to the combination of splinting, NSAIDs and corticosteroid injections [12] [13].

The majority of patients with De Quervain tenosynovitis respond well to non-surgical treatments. Surgery is only recommended for patients who do not respond to conservative measures and retain pain and inflammation [14]. Surgical procedures aim to relieve tendon pressure by opening the covering of the dorsal compartment. This will provide more space for the tendons and potentially decrease irritation and reestablish unimpeded gliding of the APL and EPB. Endoscopic release surgery of the 1st extensor compartment with partial surgical removal (1/4) of the extensor retinaculum is effective and associated with fewer complications than open release surgery. Longitudinal incisions during surgery have been shown to produce fewer and less painful scars compared to transverse incisions. If hypertrophic scarring occurs after surgery it can be treated with injections of corticosteroids. After surgery, a splint will be placed on the wrist and over time, patients who receive surgery should expect thumb and wrist function to return to normal.

Patients diagnosed with De Quervain tenosynovitis have an exceptional prognosis. After treatment and resolution of inflammation, patients typically regain complete function of their thumb and wrist. If patients continue to perform repeated thumb and wrist motions that contribute to this disease, a brace may be worn during these activities.

De Quervain tenosynovitis is caused by frequent thumb usage along with wrist deviation towards the radius, trauma or inflammation associated with arthritis. Common movements associated with De Quervain tenosynovitis include grasping, pinching, knitting and texting. Individuals who constantly play video games or the piano, garden, golf, fly fish or knit are likely to perform these motions. Repeated movements, such as those listed, that squeeze the APL and EPB against the bony wrist processes, result in increased friction which causes the tendon to swell. Once the APL and EPB tendon swell and the sheath surrounding them becomes inflamed, they are no longer able to fit in the narrow canal in the wrist near the thumb. Patients with De Quervain tenosynovitis usually experience pain when moving the thumb and gripping objects [3]. Women have a much higher chance (10 times) of developing De Quervain tenosynovitis than men and the disease most commonly occurs after having children between the ages of 30 and 50 years of age [4].

Of diseases affecting the tendons of the hand, De Quervain tenosynovitis is very common, second only to trigger finger. Approximately 77% of cases occur in women and the onset of this disease is most often in the 4th to 6th decade of life. Excessive use of the thumb is the most common cause of De Quervain tenosynovitis although trauma to the wrist or thumb is also a contributing factor. Women in the nursing, secretarial and childcare profession along with mothers are at especially high risk for developing this disease [5].

The tendons of the abductor pollicis longus (APL) and the extensor pollicis brevis (EPB) both pass from the wrist to the thumb through the first dorsal compartment. The APL is much larger than the EPB and is composed of multiple tendon strands. Some individuals may only have an APL due to congenital defects. Both of these tendons are innervated by the same nerve, have the same blood supply and function to abduct the wrist radially and extend the thumb. During surgical repair of the wrist, a septum is frequently observed which physically separates the APL and EPB [6].

Prevention of De Quervain tenosynovitis is achieved through appropriate health and exercise practices. This may include properly warming up before physical activities, ensuring adequate rest in between physical activities and maintaining fitness, flexibly, strength and endurance. It is always important to utilize appropriate techniques while performing physical activities.

De Quervain tenosynovitis occurs when the fluid filled sheath surrounding the thumb tendons (abductor pollicis longus (APL) and extensor pollicis brevis (EPB)) is inflamed or when the tendons themselves are strained [1] [2]. Patients with De Quervain tenosynovitis will experience pain in the region of the wrist closest to the thumb, especially when the thumb is being used (eg. making a fist). The function of a tendon sheath is to produce and hold lubricating fluid around the tendon, which reduces friction and allows easy movement. Inflammation of the sheath around a tendon will hinder smooth tendon movement. The specific tendons involved in De Quervain tenosynovitis (APL and EPB) are essential for thumb, hand and wrist movement. Since both the APL and EPB pass through a narrowing opening where the thumb and wrist meet, pain is typically felt in this region. This condition has been observed for over 100 years and surgeons agree on a standard method to treat De Quervain tenosynovitis which is broadly used.

De Quervain tenosynovitis is a condition that causes pain in the wrist at the base of the thumb due to inflammation of the tendons that extend the thumb (the abductor pollicis longus (APL) and extensor pollicis brevis (EPB)). De Quervain tenosynovitis is most commonly caused by overuse of the thumb or wrist through repetitive actions such as knitting, playing video games and lifting a baby, but it can also be caused by trauma. Women are much more likely to develop De Quervain tenosynovitis (70% of cases are women) and women who are pregnant or have diabetes have the highest chance of developing this disease.

Patients who have De Quervain tenosynovitis may experience pain on the side of the wrist closest to the thumb, especially when grasping an object or twisting the wrist. Also, an audible sound may be observed when moving the thumb or wrist. Patients with De Quervain tenosynovitis may also observe swelling near the base of the thumb due to fluid buildup. If left untreated, pain may radiate up the arm and to the tip of the thumb.

De Quervain tenosynovitis is diagnosed through physical exams of the wrist and thumb, including the Finkelstein test. The Finkelstein test involves making a fist and twisting the wrist outwardly. If pain at the base of the thumb is experienced while performing this action you may have De Quervain tenosynovitis. X-rays and other imaging tests are not needed to diagnose the condition, but may be performed in order to rule out other causes of wrist pain.

Successful treatment of De Quervain tenosynovitis typically requires non-surgical means including rest, heat, nonsteroidal anti-inflammatories (NSAIDs) and splints. NSAIDs, splinting and injection of corticosteroids into the APL and EPB were shown to be effective in up to 90% of cases. If pain persists after these treatment measures, surgery to relieve pressure in the compartment that houses the APL and EPB will be performed. Treatments for De Quervain tenosynovitis are very effective and the majority of patients will experience a full recovery.

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