De Quervain syndrome

Overview

De Quervain syndrome, also known as De Quervain's tenosynovitis, is a painful inflammatory condition affecting the tendons on the thumb side of the wrist. It primarily involves inflammation of two tendons—abductor pollicis longus and extensor pollicis brevis—which pass through a tight tunnel at the wrist known as the first dorsal compartment. This inflammation leads to swelling, friction, and pain, particularly during thumb or wrist movement. The condition is common among individuals who frequently perform repetitive hand or wrist motions.

Causes

De Quervain syndrome typically results from repetitive or prolonged activities that strain or irritate the wrist tendons. Specific causes and risk factors include:

• Repetitive movements: Frequent thumb and wrist motions such as texting, typing, gaming, gardening, or certain sports.

• Overuse: Activities requiring prolonged gripping, pinching, or twisting motions, common among manual laborers, musicians, or caregivers.

• Hormonal factors: More prevalent in pregnant or postpartum women, likely due to hormonal fluctuations causing tendon swelling.

• Injury or trauma: Direct wrist injury or repeated minor injuries causing cumulative damage.

• Inflammatory conditions: Associated with rheumatoid arthritis or other inflammatory joint diseases.

Symptoms

Symptoms of De Quervain syndrome typically develop gradually and include:

• Pain and tenderness: Pain felt along the thumb side of the wrist, especially when grasping or pinching.

• Swelling: Noticeable swelling or thickening near the base of the thumb.

• Difficulty moving the thumb: Painful and restricted thumb movement, making simple activities challenging.

• Radiating discomfort: Pain that may radiate into the forearm or thumb.

• Snapping or catching sensations: Audible or palpable snapping when moving the thumb.

Diagnosis

Diagnosis of De Quervain syndrome is usually clinical, based on medical history, symptoms, and physical examination. Diagnostic steps include:

• Finkelstein’s test: A simple clinical test involving bending the thumb across the palm and flexing the wrist toward the little finger. Pain elicited during this maneuver strongly suggests De Quervain syndrome.

• Physical examination: Assessing tenderness, swelling, and the range of motion in the wrist and thumb.

• Imaging tests: X-rays, ultrasound, or MRI are occasionally used to exclude other conditions such as arthritis or fractures, though they typically appear normal in De Quervain syndrome.

Treatment

Treatment for De Quervain syndrome aims to relieve pain, reduce inflammation, and restore normal function. Approaches include:

• Rest and activity modification: Avoiding or limiting activities that aggravate symptoms.

• Splinting or bracing: Immobilizing the wrist and thumb to allow inflammation to subside.

• Nonsteroidal anti-inflammatory drugs (NSAIDs): Medications such as ibuprofen or naproxen for pain and inflammation relief.

• Corticosteroid injections: Direct injection into the affected tendon sheath to significantly reduce inflammation.

• Physical or occupational therapy: Exercises and stretches to improve wrist strength, flexibility, and function.

• Surgery: If symptoms persist despite conservative treatments, a minor surgical procedure (tendon sheath release) can effectively relieve symptoms.

Prognosis

The prognosis for individuals with De Quervain syndrome is generally excellent. Most patients respond well to conservative treatments, experiencing significant relief from symptoms. However, recurrence is possible, especially if repetitive or strenuous wrist activities continue. Surgical treatment, if required, has a very high success rate, typically resolving symptoms completely. Early recognition and treatment usually lead to rapid improvement and return to normal activity levels.