De Quervain syndrome


De Quervain syndrome refers to inflammation of two tendons that control movement of the thumb and their tendon sheath.

It is also known as gamer’s thumb or mother‘s thumb.

It is characterized by pain and swelling of the radial aspect of the wrist that is exacerbated with thumb motion particularly flexion and extension.

It causes pain at the outside of the wrist.

The pain of De Quervain syndrome is typically increased with gripping or rotating the wrist.

The thumb may also be difficult to move smoothly.

Onset of symptoms is usually gradual.

It is suggested that thickening and degenerative changes of the synovial sheath containing the first dorsal extensor tendons (abductor pollicis longus and extensor pollicis brevis) may contribute to irritation of these tendons with pain and discomfort on the radial side of the wrist.

Findings include fibrosis but not typically inflammation.

Middle aged persons are most often affected.

Risk factors for the development of DQS: Repetitive movements, pregnancy, trauma, rheumatic diseases.

Frequency about 1%: The condition affects about 0.5% of males and 1.3% of females.

The diagnosis is generally based on symptoms and physical examination.

Treatment: avoiding activities that bring on the symptoms, NSAIDs, and splinting the thumb.

If conservative measures are not effective steroid injections or surgery may be recommended.

Cause of de Quervain’s disease is not known.

A systematic review of potential risk factors did not find any evidence of a causal relationship with occupational factors.

However, researchers have 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.

Some suggest it is a repetitive strain injury where the thumb is held in abduction and extension to be predisposing factors.

Individuals performing rapid repetitive activities involving pinching, grasping, pulling or pushing are considered at increased risk.

Potential risk factors include:computer mouse use, trackball use, typing, bowling, golf, fly-fishing, piano-playing, sewing, and knitting.

Increased incidence in association with smartphone use.

Women are affected more often than men, by 2.6 times.

Peak incidence occurs between 40 and 59 years of age, and old reports suggest it affects 0.5% of men at 1.3% of women.

Commonly occurs during and after pregnancy., due to hormonal changes and fluid retention.

Findings include noninflammatory thickening of the tendons in the synovial sheaths that the tendons run through.

The two tendons involved with De Quervain syndrome are those of the extensor pollicis brevis and abductor pollicis longus muscles.

These two muscles function to bring the thumb away from the hand; the extensor pollicis brevis brings the thumb outwards radially, and the abductor pollicis longus brings the thumb forward away from the palm.

The process affects the tendons of these muscles as they pass from the forearm into the hand via a fibro-osseous tunnel.

Histopathological analysis shows a thickening and myxoid degeneration consistent with a chronic degenerative process, as opposed to inflammation.

Such pathology is identically seen in new mothers.

The diagnosis is a clinical one.

Diagnostic imaging may be used to rule out fracture, arthritis, or other causes.

Differential diagnosis includes intersection syndrome, thumb joint arthritis, or radial nerve compression.

The Finkelstein maneuver, clasping the thumb within a closed fist and deviating the wrist in the ulnar direction to hyperflex the thumb reliably reproduces symptoms.

Non-operative first line treatment for de Queverain tenosynovitis consists of nonsteroidal anti-inflammatory drugs, splint immobilization of the wrist and thumb, or corticosteroid injection.

Immobilization and corticosteroid injection are assisted with better outcomes.

When non-operative treatment fails, surgical release of the first dorsal extensor compartment through open, endoscopic, or percutaneous approaches are effective.


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