De Quervain syndrome

De Quervain syndrome occurs when two tendons that control movement of the thumb become constricted by their tendon sheath in the wrist.^[3][5][6] This results in pain and tenderness on the thumb side of the wrist.^[3] Radial abduction of the thumb is painful.^[6] On some occasions, there is uneven movement or triggering of the thumb with radial abduction.^[4] Symptoms can come on gradually or be noted suddenly.^[4]

The diagnosis is generally based on symptoms and physical examination.^[3] Diagnosis is supported if pain increases when the wrist is bent inwards while a person is grabbing their thumb within a fist.^[4][6]

Treatment for de Quervain tenosynovitis focuses on reducing inflammation, restoring movement in the thumb, and maintaining the range of motion of the wrist, thumb, and fingers.

Symptoms are pain and tenderness at the radial side of the wrist, fullness or thickening over the thumb side of the wrist, painful radial abduction of the thumb, and difficulty gripping with the affected side of the hand.[2] Pain is made worse by movement of the thumb and wrist, and may radiate to the thumb or the forearm.^[2] The onset is often gradual, but sometimes the symptoms seem to come on suddenly and the problem is often misinterpreted as an injury.^[2]

Causes

The cause of de Quervain syndrome is not established. Critics of this association note of the human mind's tendency to misinterpret activities that are painful as activities that make the problem worse.

Women are diagnosed more often than men.[11] The syndrome commonly occurs during and, even more so, after pregnancy.^[15] Contributory factors may include hormonal changes, fluid retention and—again, more debatably—increased housework and lifting.^[15][16]

Pathophysiology

De Quervain syndrome involves noninflammatory thickening of the tendons and the

Diagnosis

De Quervain syndrome is diagnosed clinically based on patient history and physical examination, though diagnostic imaging may be used to rule out fracture, arthritis, or other causes. The modified

1. Osteoarthritis of the trapezio-metacarpal joint
2. Intersection syndrome: Pain will be more towards the middle of the back of the forearm and about 2–3 inches below the wrist, usually with associated crepitus.
3. Wartenberg's syndrome: The primary symptom is paresthesia (numbness/tingling).

Treatment

Most tendinoses and enthesopathies^[19][20] are self-limiting and the same is likely to be true of de Quervain syndrome, although further study is needed.^[21][22][23]

The mainstay of symptom alleviation (palliative treatment) is a

As with many musculoskeletal conditions, the management of de Quervain disease is determined more by convention than scientific data. A systematic review and meta-analysis published in 2013 found that corticosteroid injection seems to be an effective form of conservative management of de Quervain syndrome in approximately 50% of patients, although they have not been well tested against placebo injection.[25] Consequently, it remains uncertain whether injections are palliative and whether they can alter the natural history of the illness.^[21][22][23] One of the most common causes of corticosteroid injection failure is the presence of subcompartments of the extensor pollicis brevis tendon.^[26]

Surgery (in which the sheath of the first dorsal compartment is opened longitudinally) is documented to provide relief in most patients.^[27] The most important risk is to the radial sensory nerve. A small incision is made and the dorsal extensor retinaculum is identified. Once it has been identified, the release is performed longitudinally along the tendon. This is done to prevent potential subluxation of the first compartment tendons. Next, the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) are identified, and the compartments are released.^[26]

Some occupational and physical therapists suggest alternative lifting mechanics based on the theory that the condition is due to repetitive use of the thumbs during lifting. In addition, physical/occupational therapists can suggest activities to avoid (based on the theory that certain activities might exacerbate the condition) and can introduce strengthening exercises (based on the theory that this will contribute to better form and promote the use of other muscle groups, which might limit irritation of the tendons).^{[citation needed]}

Some occupational and physical therapists use other treatments in conjunction with therapeutic exercises, based on the rationale that they reduce pain and promote healing: ultrasound, short-wave diathermy, or other deep heat treatments, as well as

History

From the original description of the illness in 1895 until the first description of corticosteroid injection by Jarrod Ismond in 1955,^[28] it appears that the only treatment offered was surgery.^[28][29][30] Since approximately 1972, the prevailing opinion has been that of McKenzie (1972) who suggested that corticosteroid injection was the first line of treatment and surgery should be reserved for unsuccessful injections.^[31]

Eponym

It is named after the Swiss surgeon Fritz de Quervain, who first identified it in 1895.^[32] It should not be confused with de Quervain's thyroiditis, another condition named after the same person.^{[citation needed]}

See also

• Problematic smartphone use
• Nomophobia

References