DEQUERVAIN'S TENDINITIS

What is it?

deQuervain’s tendinitis is a condition of friction and inflammation around the tendons of two thumb muscles, because of a tight tube of collagen tissue. The friction and inflammation can cause pain and tenderness along the thumb side of the wrist, usually noticed when gripping with the thumb or pinching. At times it causes a sharp pain with stretching the thumb away from the palm.

What causes it?

The cause of deQuervain’s tendinitis is thought to be mechanical overload of the tube with increased thumb use or loading. For example, awkward hand positions required by a new mother in caring for an infant is a common cause of this condition. Other examples are working the weekend in the garden, or moving house.

Signs and symptoms.

Pain over the thumb side of the wrist is the main symptom. The pain may appear either gradually or suddenly. It is felt in the wrist and can travel up the forearm. The pain is usually worse with use of the hand and thumb, especially when forcefully grasping things. Swelling over the thumb side of the wrist is noticed and may be accompanied by a small cyst. There may be an occasional “catching” or “snapping” when moving the thumb. Because of the pain and swelling, it may be difficult to move the thumb and wrist, such as in pinching. Irritation of the nerve lying on top of the tendon sheath may cause numbness on the back of the thumb and index finger.

Diagnosis.

A Finkelstein test is usually very painful. In this test, the patient makes a fist with the fingers over the thumb. The wrist is then bent in the direction of the little finger causing pain. Tenderness directly over the tendons on the thumb-side of the wrist is also found.

Treatment.

The goal is to reduce the inflammation and tightness. Usually a steroid injection will be used, and can relieve and cure about 80 % of cases.

When symptoms are severe or do not improve, surgery may be recommended. The surgery opens the tunnel to make more room for the irritated tendons. Normal use of the hand can usually be resumed once comfort and strength have returned, over about 1 to 3 weeks.