De Quervain's Tenosynovitis

Definition

De Quervain's tenosynovitis is classically associated with localized tenderness, swelling, and pain in the wrist radiating into the forearm and distally into the thumb.

Description

Tendinitis is inflammation of a tendon (a fibrous cord that joins muscle to bone or muscle to muscle, made up principally of bundles of collagen and containing some blood vessels).

Tenosynovitis is inflammation of the tendon sheath caused by calcium deposits, repeated strain or trauma, high levels of blood cholesterol, rheumatoid arthritis, gout, or gonorrhea.

De Quervain's disease, an inflammatory disorder that can be caused by cumulative injury, is one of the most commonly diagnosed problems seen by hand surgeons. Carpal tunnel syndrome, also thought to be caused by cumulative trauma, is a major cause of lost workdays.

De Quervain's disease and carpal tunnel can occur singly or in combination.

Symptoms

De Quervain's tenosynovitis is classically associated with localized tenderness and swelling in the region of the styloid process of the radius bone and wrist pain radiating into the forearm and into the thumb. Other findings may include decreased range of motion of the lower joint of the thumb and crackling noises over the tendon when moving it.

With de Quervain's tenosynovitis, there is potential for symptoms in the arm other than those involving the tendon. These symptoms can result from the close proximity of the nerves, tendons, tendon sheaths, and fascia of the forearm to the site of inflammation.

Diagnosis

Diagnosis of de Quervain's tenosynovitis is based on the location of the patient's pain and the presence of swelling in the hand and decreased hand function.

Treatment

Symptomatic relief is provided by rest or immobilization (splint) of the part, application of heat or cold (whichever benefits the patient), and nonsteroidal anti-inflammatory drugs (NSAIDs).

Controlled exercise several times daily (becoming progressively more active with tolerance) is indicated, especially to prevent frozen shoulder, after the acute inflammation is controlled. Injection within the tendon sheath of a corticosteroid indicated for soft-tissue injection may be helpful.

Surgery is rarely necessary. A disabling complication of surgery for de Quervain's tenosynovitis is a painful neuroma of the radial nerve.

Questions to Ask Your Doctor

Are there symptoms of repetitive trauma?

Is the diagnosis de Quervain's tenosynovitis?

What are the possible complications if left untreated?

What are the treatment options?

Will injections help?

Is surgery necessary?

What are the risks of surgery?