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De Quervain's tenosynovitis

Definition


Disease: De Quervain's tenosynovitis De Quervain's tenosynovitis
Category: Bones, joints, muscles diseases

Disease Definition:

 

Daily activities and leisure ones like gardening, playing music, knitting and cooking can be entertaining unless they cause pain in the wrist and hand. This condition is called de Quervain's tenosynovitis.

 

If someone has de Quervain's tenosynovitis, the sheath of tendons on the thumb side of the wrist becomes inflamed or swollen, limiting the movement of the tendons. This will result in pain and discomfort every time the person grabs something, makes a fist or turns their wrist.

 

If treatment starts early, symptoms of de Quervain's tenosynovitis could subside in 4 to 6 weeks. In mild cases, this condition could be treated with immobilizing the wrist and taking medications, while in more serious cases, surgery may be necessary.
 

Work Group:


Symptoms, Causes

Symptoms:

Pain and swelling near the root of the thumb are the major symptoms of de Quervain's tenosynovitis. The wrist pain could either become increased over time or it could appear suddenly. If this goes on without proper treatment, the pain could expand into the thumb, back into the forearm or both. The pain may be aggravated by other movements like pinching, punching or grasping.

 

Some of the signs and symptoms that this condition may cause are:

 

  • Numbness in the back of the thumb and index finger, due to the swollen tendon rubbing on a nerve
  • Swelling near the base of the thumb
  • Pain near the base of the thumb
  • A "sticking" or "stop-and-go" sensation in the thumb when trying to move it
  • A fluid-filled cyst in the same area as the pain and swelling
  • A squeaking sound as the tendons try to move back and forth through the inflamed sheaths
  • Having difficulty moving the thumb and wrist when doing things that involve pinching or grasping
     

Causes:

Two major tendons in the wrist and lower thumb are used when someone tries to grip, grasp, clench, pinch or wring anything in their hand. They work simultaneously from the forearm of the hand through the thumb side of the wrist. Normally, they glide unhindered through a small tunnel connecting them to the root of the thumb. In de Quervain's tenosynovitis, the slipperiness is hampered by the inflammation, restricting the movement of the tendons.

 

Chronic overuse of the wrist is a common cause of this condition.
FOR EXAMPLE: peeling potatoes or carrots is a simple repetitive action, a bent wrist and gripping of the peeler. But peeling carrots or potatoes day after day may be sufficient for the sheath around the tendons to be irritated.

 

Some of the other factors that may end up causing this condition are:

 

  • Rheumatoid arthritis or some other type of inflammatory arthritis
  • The forming of scar tissue due to a direct injury to the wrist or tendon. This can restrict the movement of the tendons.
     

Complications

Complications:

This condition may irreversibly restrict the movement of the wrist if it is left untreated, making pinching, grasping or making a fist a difficult action to carry out. The tendon sheaths may rupture. Moreover, someone may experience further pain and discomfort in case an underlying infection spreads into the hand or the arm.
 

Treatments:

The initial treatment of de Quervain's tenosynovitis will be aimed at reducing pain and swelling. It may include:

 

  • Icing the affected area or applying heat to it
  • Avoiding pinching with the thumb when moving the wrist from one side to another
  • Using nonsteroidal anti-inflammatory medications, such as naproxen or ibuprofen.
  • Immobilizing the thumb and wrist, holding them straight within a splint or brace in order to help rest the tendons.
  • Avoiding repetitive thumb movements whenever possible

 

In order to reduce swelling, the patient may be advised injections of corticosteroid medications into the tendon sheath.

 

Discovered early, treatment of de Quervain's tenosynovitis is usually successful. Yet, overuse injuries might reoccur if the person cannot stop the repetitive motion that caused the complication first hand.

 

HOW TO MAKE ADJUSTMENTS??

A medical team including a physical therapist or occupational therapist can monitor the patient's habits and advise them on how to make necessary alteration to ease their wrist.  The doctor could also give the patient wrist, hand or arm focused exercises that empower those muscles, reduce pain and limit tendons' irritation.

 

In more serious cases, the doctor might recommend outpatient surgery that involves a procedure to inspect the sheath around the inflamed tendon and to open the sheath to release pressure.
 

Prognosis:

Not available

Expert's opinion

Expert's Name:
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Expert's opinion:

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Clinical Trials:

Not available

 

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