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Post subject: De Quervain's Stenosing Tenosynovitis  PostPosted: Oct 06, 2005 - 09:01 AM

De Quervain's Stenosing Tenosynovitis

Once called Washer Woman's Sprain, this painful inflammation of the thumb side of the wrist now bears the name of the Swiss surgeon, Fritz de Quervain, who wrote about it in 1895.

Passing over the back (or dorsal surface) of the wrist are the tendons for muscles that extend or straighten the fingers and thumb and lift the hand at the wrist. These tendons run through six lubricated tunnels (compartments) under a thick fibrous layer called the extensor retinaculum or dorsal carpal ligament. Your Indiana Hand Center physician will demonstrate this area to you on your own hand.

The first dorsal compartment lies over the bony bump at the base of the thumb. Through it pass the tendons for the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) muscles. Both of these muscles help spread and extend the thumb away from the rest of the hand. They are necessary for a powerful grasp and also help to move the wrist.
What is it?

De Quervain's stenosing tenosynovitis is a painful inflammation of the tendons in the first dorsal compartment of the wrist. The lubricating synovial sheath lining this compartment thickens and swells giving the enclosed tendons less room to move. The tendons, in turn, may swell beyond this constriction. Fine, fibers of scar (adhesions) may form between the sheaths and tendons.

What Causes it?
This inflammation may be caused by anything that changes the shape of the compartment or causes swelling or thickening of the tendons. Repetitive trauma, overuse, or an inflammatory process are likely causes, but frequently, the cause of the disease is unknown.

Who Gets it?
De Quervain's stenosing tenosynovitis occurs most often in individuals between the ages of 30 and 50. Women are afflicted with it 8 to 10 times more often than men. People who engage in repetitive activities requiring sideways motion of the wrist while gripping the thumb, as in hammering, skiing, some assembly line jobs, etc., may be predisposed to developing this disorder.

What are the Signs and Symptoms?

Pain over the thumb side of the wrist is the primary symptom. It may occur "overnight" or gradually, and it may radiate into the thumb and up the forearm. It is worse with the use of the hand and thumb, especially with any forceful grasping, pinching, or twisting. Swelling over the thumb side of the wrist may be present, as well as some "snapping" when the thumb is moved. Because of the pain and swelling, there may be some decreased thumb motion.

Besides pain and swelling over the first dorsal compartment, having a positive Finkelstein's test is a good indication the patient has this disease. In this test, the patient makes a fist with his/her thumb placed under his/her little finger, and bends the wrist. This test is mildly painful to many of us, but to someone with de Quervain's stenosing tenosynovitis, it is very painful.

Conservative Management

Your Hand Center doctor may first try to reverse the course of the disease with a 3 to 6 week trial on an anti-inflammatory medication while the thumb and wrist are rested by wearing a wrist and thumb spica splint. The physician may also inject the inflamed area with a steroid to help decrease the inflammation.

If Surgery is Necessary

If the symptoms of de Quervain's stenosing tenosynovitis disease are long-standing or unresponsive to conservative management, surgery is indicated. This is usually performed on an outpatient basis.

A longitudinal incision is made over the first dorsal compartment. The dorsal carpal ligament is cut to expose the tendons. The tendons from APL and EPB are identified and motion is checked, the wound is closed, and a compressive dressing is applied.

Post-op Therapy

A prescription for pain medication will be provided. You should expect some pain, especially the first three days. The bulky dressing is removed at one of The Indiana Hand Center offices a few days after surgery, and an exercise program for the thumb and wrist is started. It is important to do the exercises as prescribed. De Quervain's stenosing tenosynovitis rarely recurs after proper surgical intervention. Complications may occur if not treated.


PHOTO CAPTION: Finkelstein's test.

Medical Information
It is not the intention of Raptor-Pack to provide specific medical advice but rather to provide users with information to better understand their health and their diagnosed disorders. Specific medical advice will not be provided, and Raptor-Pack urges you to consult with a qualified physician for diagnosis and for answers to your personal questions and specific medical advice






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