De Quervain's syndrome is a strong and persistent pain in the thumb that can make everyday activities very difficult. Young mothers know something about it, but also carpenters, painters, tennis players and even text message enthusiasts. How to recognize and treat de Quervain's syndrome, i.e. wrist tenosynovitis?

de Quervain's syndromeis a chronic inflammation of the tendon sheath of the wrist. It belongs to a group of disorders called enthesopathies, i.e. lesions of the tendon attachments to the bone. In de Quervain's syndrome, the inflammation involves the tendon sheaths of the short extensor of the thumb and the long abductor of the thumb. The pain occurs when the thumb is straightened and abducted and it radiates to the forearm, which significantly affects the quality of life. Basic activities such as brushing your teeth and buttoning buttons can be very painful.

de Quervain syndrome: causes

This disease occurs four times more often in women than in men. Colloquially, de Quervain's syndrome is also called "mother's thumb". Women who lift babies frequently and repeatedly put a strain on their wrists. In addition, they perform other unfavorable activities, such as hand washing. Overload seems to be the cause of inflammation of the tendon sheath, although the etiology of this disease is not fully understood. We meet it in people who perform work involving monotonous bending and straightening the thumb, e.g. carpenters or painters. Also musicians - for example pianists - complain of pain in the thumb. De Quervain's team may concern athletes (mainly tennis players), computer graphic designers and people who frequently write text messages with the thumb of a hand holding the phone at the same time. If the movement repeats, it becomes overloaded, resulting in inflammation of the tendon sheath. There are other reasons for de Quervain's syndrome:

  • wrist injury, mainly scar formation on the tendon sheath
  • bone changes, also as a result of trauma, within the distal epiphysis of the radius
  • inflammatory process, e.g. caused by rheumatoid arthritis (RA) leading to post-inflammatory adhesions

Diagnosis of wrist tenosynovitis

Characteristic for de Quervain's syndrome is the so-called symptomFinkelstein. A patient who comes to the doctor with thumb pain should be asked to perform the following movement: bend the thumb and bend the remaining fingers over it (fist with thumb in the center), then tilt the hand towards the elbow (outward). If there is pain at this point, it is very likely de Quervain's syndrome. There is also an audible crunch that may sometimes be heard during this movement, which is reminiscent of walking on snow. It results from the fact that the inflammation of the tendon sheath makes it difficult for the tendons to slide inside it. An additional confirmation of the diagnosis will be the red and swollen skin over the tendons of the extensor and thumb abductor (but this symptom does not have to occur). In addition, the patient may feel:

  • jumping tendons over the styloid process of the radial bone (i.e. at the base of the thumb) and tactile pain in this place (when the inflammatory process also affects the nerves)
  • pain during the "O.K." gesture (thumbs up)
  • general hyperalgesia of the wrist area
  • weakening of muscles, mobility and efficiency of the hand
  • problem with grasping, clenching hands

Treatment of de Quervain's syndrome

When we experience the described pain in the thumb and wrist, the first instinct is to start saving the sick hand, apply cool compresses, or lubricate it with over-the-counter ointments (e.g. with ketoprofen or diclofenac) and wrap it with a bandage to slightly stiffen it.

Restriction of movement in itself can only lead to muscle weakness and increasing pain, and ultimately to the formation of contractures. Therefore, only by avoiding moving the sick thumb will not cure de Quervain's disease.

Often these home remedies help. However, if the pain persists after a few days, you should see your doctor. A specialist (orthopedist, rheumatologist, or even a general practitioner) may order an ultrasound if he or she has doubts about the diagnosis. It should also rule out (X-ray will help, as de Quervain's syndrome itself does not give a clear X-ray image) diseases with similar symptoms, such as Wartenberg's syndrome, cross-border syndrome, or osteoarthritis of the thumb. In the treatment of de Quervain's syndrome, injections of corticosteroids (the so-called blockade) are used to stop the development of inflammation and reduce pain. Additionally, the patient should avoid activities that aggravate pain; grabbing heavy things, clenching your fists. Sometimes this is enough to cure de Quervain's syndrome.

Important

Good results in the treatment of de syndromeQuervaina brings rehabilitation - analgesic and anti-inflammatory treatments, such as cryotherapy, iontophoresis, and centrifugal baths. Accelerating and regenerating treatments such as magnetic fields, laser therapy and ultrasound are also beneficial. After a period of acute pain, gentle exercises under the supervision of a physiotherapist are recommended. It is worth getting interested in kinesiotaping, i.e. the recently fashionable dynamic taping.

Operation - when nothing else helps

Occasionally, however, the symptoms of de Quervain's syndrome keep recurring. Then it may turn out that the only solution is surgery. It consists in cutting the inflamed tendon sheath. This releases the tendons and allows them to slide freely. Any post-inflammatory adhesions are also removed during the operation. After the recovery period, it is worth considering changing your lifestyle habits and learning, for example, to work in a different way so that the problem does not recur.

About the authorMarta Uler A journalist specializing in he alth, beauty and psychology. She is also a diet therapist by education. Her interests are medicine, herbal medicine, yoga, vegetarian cuisine and cats. I am a mother of two boys - a 10-year-old and a 6-month-old.

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Spine, bones, joints