De Quervain syndrome: symptoms, causes, diagnosis and treatment
De Quervain’s syndrome (a.k.a. tenosynovitis) named after the Swiss surgeon who described it, is an inflammation of the sheath that covers two of the tendons that allow the movement of the thumb (the long abductor and the short extensor). These tendons from the forearm reach the wrist and the thumb, through a sheath. In the presence of an inflammatory state, the sheath thickness increases and the available space for the passage of the tendons decreases. As a result, the friction between the tendons and the radial styloid (the bone protrusion over which the tendon passes before reaching the fingers) increases.
The most common symptom of De Quervain’s syndrome is a localized pain at the edge of the wrist and along the back of the thumb during gripping, finger-engaging, or wrist tilt movements. It can be associated with a visible swelling of the sheath and a tingling sensation. Consequently, this condition can greatly limit the function of the hand, making it difficult to perform even simple daily tasks, for example turning a key in a lock or opening a canister.
What are the main causes of De Quervain’s syndrome?
- Rheumatic pathologies
- Sudden functional overloads
- Predisposition to inflammation
- Activities involving violent or very repetitive movements: musicians, embroiderers, mothers in the last period of breast-feeding (when holding the baby is tiring because of its weight).
The doctor can make the diagnosis through clinical observation. In fact the area is swollen and painful upon palpation. In addition, the Finkelstein test can be performed to assess the degree of pain. The patient is asked to close his or her hand in a fist, squeeze the thumb with the other fingers and flex the wrist toward the little finger. The ultrasound allows evaluating the inflammatory state of the tendons.
If De Quervain’s syndrome is in an early stage, a conservative approach can be attempted with a functional rest of the hand (avoiding movements that cause pain for a certain period), cryotherapy (ice on the radial styloid to reduce pain), administering anti-inflammatory drugs, prescribing instrumental therapies (Tecar, laser, etc.) and, in the most severe cases, corticosteroid infiltrations. However, when the pain is intense and symptoms are severe, surgery may be necessary, under local anesthesia, and without requiring a hospital stay. The intervention is aimed at opening the tendon sheath to allow the tendons to pass easily. Surgery is decisive and functional recovery is almost immediate.
UPMC Institute for Health Chianciano Terme offers outpatient orthopedic surgery with no required hospitalization.
For further information: +39 0578 61198