DeQuervain’s tenosynovitis, is characterized by irritation or swelling of the tendons on the thumb side of the wrist. The inflammation thickens the tendon sheath (tenosynovium) and constricts the tendon as it glides in the sheath. This is common in individuals that work on computers or repetitively use their hands. Among Missouri athletes this syndrome occurs in discus throwers and golfers as a result of repetitive extensive ulnar deviation of the wrist
Ulnar deviation of the wrist strains the tendons of the abductor pollicis longus and the extensor pollicis brevis muscles under the retinaculum that covers the first dorsal compartment of the wrist at the radial styloid level. Repetitive angulation of these tendons causes tenosynovitis in this fibro-osseus tunnel.
Clinical Symptoms of DeQuervain’s Tenosynovitis:
Patients report local tenderness, swelling and “creaking” over the radial styloid. The pain is aggravated by attempts to move the thumb or make a fist.
Examination reveals swelling and tenderness over the synovial compartment in the region of the distal radius. Crepitation may be palpable as the patient moves and actively flexes and extends the digit. Finkelstein’s test is often positive (The thumb and hand are forced and deviated toward the ulnar side, and the test is considered positive when the patient experiences an extensive pain over the radial styloid process).
Therapy for DeQuervain’s Tenosynovitis:
Initial treatment should consist of immobilization of the thumb with a thumb spica splint that immobilizes both the wrist and thumb. A short course of NSAIDS (2 weeks) is often helpful for pain relief and reduction of inflammation in the fibro-osseus tunnel. If immobilization fails, injection with a corticosteroid into the tendon sheath followed by concurrent thumb spica splint. No more than 3 injections should be preformed; at this point surgical consideration should be considered.
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