Diagnosis ĭe Quervain syndrome is diagnosed clinically, based on history and physical examination, though diagnostic imaging such as X-ray may be used to rule out fracture, arthritis, or other causes, based on the person's history and presentation. The pathology is identical in de Quervain seen in new mothers. De Quervain tendinopathy affects the tendons of these muscles as they pass from the forearm into the hand via a fibro-osseous tunnel (the first dorsal compartment).Įvaluation of histopathological specimens shows a thickening and myxoid degeneration consistent with a chronic degenerative process, as opposed to inflammation. These two muscles run side by side and function to bring the thumb away from the hand (radial abduction) the extensor pollicis brevis brings the thumb outwards radially, and the abductor pollicis longus brings the thumb forward away from the palm. The two tendons concerned are those of the extensor pollicis brevis and abductor pollicis longus muscles. The extensor tendon sheaths on the back of the wrist.ĭe Quervain syndrome involves noninflammatory thickening of the tendons and the synovial sheaths that the tendons run through. Contributory factors may include hormonal changes, fluid retention and-again, more debatably and potentially harmfully-increased housework and lifting. The syndrome commonly occurs during and, even more so, after pregnancy. Specific activities that have been postulated as potential risk factors include intensive computer mouse use, trackball use, and typing, as well as some pastimes, including bowling, golf, fly-fishing, piano-playing, sewing, and knitting. These movements are associated with many types of repetitive housework such as chopping vegetables, stirring and scrubbing pots, vacuuming, cleaning surfaces, drying dishes, pegging out washing, mending clothes, gardening, harvesting and weeding. Workers who perform rapid repetitive activities involving pinching, grasping, pulling or pushing have been considered at increased risk. Proponents of the view that De Quervain syndrome is a repetitive strain injury consider postures where the thumb is held in abduction and extension to be predisposing factors. However, researchers in France found personal and work-related factors were associated with de Quervain's disease in the working population wrist bending and movements associated with the twisting or driving of screws were the most significant of the work-related factors. A systematic review of potential risk factors discussed in the literature did not find any evidence of a causal relationship with activity or occupation. Evidence regarding a possible relation with activity and occupation is debated.
The cause of de Quervain's disease is not established. Pain is made worse by movement of the thumb and wrist, and may radiate to the thumb or the forearm.
Symptoms are pain and tenderness at the radial side of the wrist, fullness or thickening over the thumb side of the wrist, and difficulty gripping with the affected side of the hand. Surgery to release the first dorsal component is an option. Steroid injections are commonly used, but are not proved to alter the natural history of the condition. Pain medications such as NSAIDs can also be considered. Symptomatic alleviation (palliative treatment) is provided mainly by splinting the thumb and wrist.
There is some evidence that the natural history of de Quervain tendinopathy is resolution over a period of about 1 year. Diagnosis is supported if pain increases when the wrist is bent inwards while a person is grabbing their thumb within a fist. The diagnosis is generally based on symptoms and physical examination. For this reason, it's better not to blame activity without strong scientific support. Humans tend to misinterpret painful activities as causing the problem to get worse and this misinterpretation is associated with greater pain intensity. There is speculation that the problem is related to use of the hand, but this is not supported by experimental evidence. Symptoms can come on gradually or be noted suddenly. On occasion, there is uneven movement or triggering the thumb with radial abduction. Radial abduction of the thumb is painful. This results in pain and tenderness on the thumb side of the wrist. Pain medications, splinting the wrist and thumb ĭe Quervain syndrome is mucoid degeneration of two tendons that control movement of the thumb and their tendon sheath. Repetitive movements, trauma, rheumatic diseases Pain and tenderness on the thumb side of the wrist Hand surgery, Plastic surgery, Orthopedic surgery.
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