DeQuervain's syndrome
From Wikipedia, the free encyclopedia
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| Finkelstein's test for DeQuervain's tenosynovitis | |
| ICD-10 | M65.4 |
| ICD-9 | 727.04 |
| eMedicine | pmr/36 |
DeQuervain's syndrome (also known as washerwoman's sprain, Radial styloid tenosynovitis or De Quervain's disease), named for Swiss surgeon Fritz de Quervain who first identified it in 1885, is an inflammation of the sheath or tunnel that surrounds two tendons that control movement of the thumb.
It should not be confused with "De Quervain's thyroiditis" (E06.1).
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[edit] Pathology
The two tendons concerned are the tendons of the extensor pollicis brevis and abductor pollicis longus muscles. These two muscles, which run side by side, have almost the same function; the movement of the thumb into the "thumbing a ride" position. The tendons run, as do all of the tendons passing the wrist, in synovial sheaths, which contain them and allow them to exercise their function whatever the position of the wrist. In de Quervain's syndrome these tendon sheaths become inflamed, and constrict the tendons, giving rise the alternative name of "stenosing teno-vaginitis". Teno-synovitis is a similar condition in which the lining of the tendon sheaths, as distinct from the sheaths themselves, is inflamed. While the condition may be precipitated by minor injury this is not always the case, and the cause is essentially obscure.
[edit] Causes
It may be caused by the repetitive motion of the thumb constantly being required to move up and down (usually associated with using a computer keyboard or typewriter)[citation needed]. It can be included in a loose group of conditions called repetitive strain injuries.
[edit] Symptoms
Symptoms are pain and swelling over the thumb side of the wrist, possibly numbness on the back of the thumb, and difficulty gripping.
Finkelstein's test is used to diagnose DeQuervain's syndrome in people who have wrist pain. To perform the test, the thumb is placed in the closed fist and the hand is tilted towards the little finger, as shown in the image. If pain occurs at the wrist below the thumb, DeQuervain's syndrome is likely.
[edit] Treatment
Management of DeQuervain's disease involves (1) discontinuing or modifying the precipitating motions and (2) reducing the inflammation. Given the irritability of the tendons, short term splinting of the thumb via a thumb spica is often required to prevent reaggravation with activities of daily living. Frequent and localized icing for short periods of time throughout the day have as an archaic treatment been used, and will reduce the inflammation. There is no peer reviewed objective evidence to support that any electromodality such as ultrasound or other passive treatment (acupuncture) will accelerate treatment. By far the most effective method of treatment is the injection of a steroid such as hydrocortisone into the tendon sheath. This will cure all but the most recalcitrant cases; these will need surgery, which consists of laying open the inflamed section of the tendon sheath and which is always curative.
