De Quervain Tenosynovitis

De Quervain tenosynovitis is caused by an inflammation of the tendon sheats of the first dorsal compartment of the wrist. This compartment includes the tendons of the abductor pollicis longus and the extensor pollicis brevis forming the anatomical snuffbox. Patients usually report pain at the postolateral section of the wrist occasionally referred to the thumb or radial aspect of forearm.

De Quervain's Tenosynovitis is usually seen in people who use hands and thumbs repetitively. It is thus classified as a Repetitive Strain Injury (RSI). House wives, secretaries, tailors, computer users and assembly line workers are common sufferers. In some cases it also occurs after an acute isolated trauma to the wrist or nearby structures, as in a distal radial fracture. It is more common in females then in males, possibly due to the line and nature of work. It is also very common in pregnancy and postpartum periods especially during lactation.

Treatment of De Quervain Tenosynovitis

Physiotherapy may be effective in treating de Quervain tenosynovitis. In the acute stage, cryotherapy (cold packs, ice massage) is used to reduce the inflammation and oedema. Topical corticosteroids (hydrocortisone), which are driven into the subcutaneous tissues using ultrasound (phonophoresis) or faradic currents (iontophoresis) should also be used. A therapist can also help to determine possible precipitating factors and suggest activity modifications. For this musculoskeletal condition, medications serve primarily to decrease pain and inflammation. The most commonly used medications are oral nonsteroidal anti-inflammatory drugs (NSAIDs) and focal corticosteroid injection in conjunction with the rest of the rehabilitation plan.

Splinting with a thumb spica can be helpful. Unlike a typical wrist splint, a spica has a component that wraps around the thumb to provide some degree of immobilization at the first CMC joint, but, classically, it leaves the interphalangeal joint free.

Medications serve primarily to decrease pain and inflammation. The most commonly used medications are oral nonsteroidal anti-inflammatory drugs (NSAIDs) and focal corticosteroid injection in conjunction with the rest of the rehabilitation plan. Corticosteroid injections are usually the next step after everything else has failed, however tendon weakening and rupture although rare is possible. For severe unresponsive cases in which injections, splinting, and ergonomic modification of activities have failed, a referral for surgical treatment to decompress the first dorsal compartment is needed.

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