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De Quervain's Tenosynovitis

Definition

This is tendinitis at the outer edge of the wrist, slightly forward of the base of the thumb. It is related to inflammatory edema located in the sheath of two thumb tendons: the abductor pollicis longus tendon and the extensor pollicis brevis tendon.

What are the causes?

It is most often of mechanical origin, with significant wrist use and repeated stress on the thumb tendons. It can be favored by medical conditions such as diabetes.

What are the symptoms?

This tendinitis causes pain and sometimes swelling on the lateral edge of the wrist, slightly above the base of the thumb. It is triggered in particular by movements of wrist flexion-deviation (fastening a bra at the back, buckling a car seatbelt, etc.) and thumb flexion. It causes difficulty gripping or pinching objects with force. Crepitus and creaking can be felt during thumb mobilization.

What tests may be requested?

An ultrasound assessment confirms the diagnosis.

How is this condition treated?

Medical treatment is initially offered with a custom-made thermoformed splint and cortisone infiltrations. If this medical treatment fails, surgical treatment may be offered with opening of the sheath of these tendons through a small incision on the outer edge of the wrist, to allow more fluid movement. Afterwards, a dressing is left in place for 15 days with light immobilization for 10 days to limit forward displacement of the two released tendons.

What are the risks of the procedure?

  • Risks inherent to any surgery:

    • complex regional pain syndrome (formerly known as «algoneurodystrophic syndrome»): the hand becomes red, warm, swollen, and painful with persistent «electric» pain. This syndrome can last several months.

    • soft tissue infection

    • hematoma, which may resolve spontaneously or require surgical revision depending on its size.

  • Tingling on the dorsal side of the thumb or the first web space which may be transient or permanent, related to a stretch/compression injury of a skin nerve (the sensory branch of the radial nerve) that passes close to the sheath of these thumb tendons.