De Quervain’s Tenosynovitis.

Contents  The definition of De Quervain’s Tenosynovitis.  Incidence of De Quervaain’s Tenosynovitis.  Causes of De Quervain’s Tenosynovitis  Pathophysiology of De Quervain’s Tenosynovitis.  Sign Symptoms of De Quervain’s Tenosynovitis.  Diagnosis.  Management of De Quervain’s Tenosynovitis.  Prognosis.

De Quervain’s Tenosynovitis These tendons include-  The extensor pollicis brevis and  The abductor pollicis longus tendons. De Quervain's tenosynovitis is an inflammation of the sheaths of the tendons that move the thumb up and out (at the base of the thumb ).

Figure: Area of De Quervain’s Tenosynovitis.

Incidence  Between the ages of 30 and 50.  Women are afflicted with 8 to 10 times more often than men.  People who engage in repetitive activities as in hammering, skiing, etc, may predispose to developing this disorder.

Causes of De Quervain’s Tenosynovitis:  Overuse of the thumb and wrist.  It can occur as a result of an acute injury to the involved area (direct blow to the forearm or wrist, falling on the thumb).  It can also be seen in association with inflammatory arthritis such as rheumatoid arthritis.

Patho physiology: Increased vascularization of the outer sheath with edema. Increases the thickness of the sheath. Constricting the existing tendon. Microadhesions may form between the sheath and the tendon. Sheath thickness two to four times its normal size.

Signs and Symptoms:  Gradual onset of pain over the area and increase over time.  Swelling near the base of the thumb.  Numbness in the back of the thumb and index finger.  Difficulty in moving the thumb and wrist when grasping or pinching.

Diagnosis: Special Test: The Finkelstein Test. Figure: Finkelstein Test.

Treatment: Medical management:  Anti-inflammatory drug;  Cortisone injection; Surgery: The goal of surgery is to give the tendons more space so they no longer rub on the inside of the tunnel. To do this, the surgeon performs a surgical release of the roof of the tunnel.

Physiotherapy Management: Active Range of Motion (AROM); Passive Range of Motion (PROM); Cryotherapy or Cold Therapy; Electrotherapeutic Modalities: Ultra Sound therapy; Isometric exercises in case of acute cases; Progressive Resistive Exercises (PRE); Soft Tissue Mobilization; Stretching/Flexibility; Spica Splint.

Prognosis: Excellent prognosis occur. The patient can generally return to full function after the inflammation reduce with treatment. Sometimes bracing is used during future activities that involve repetitive wrist motion.