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What You Need to Know About De Quervain’s Tenosynovitis

What is De Quervain’s Tenosynovitis?

De Quervain’s Tenosynovitis is most commonly related to a repetitive stress injury. It is characterised by pain or tenderness on the thumb side of the wrist. The tendons involved are the Extensor Pollicis Brevis (EPB) and Abductor Pollicis Longus (APL). Through repetitive stress, the tendon sheaths that hold these two tendons together may become inflamed. Over time the sheath itself can become thickened. It is unlikely to be a permanent condition given that it is treated and managed well

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Figure 1: Tendons and Sheaths involved

The APL and EPB tendons are responsible for bringing the thumb in an outwards direction. Thickening of the sheath from an acute or long term repetitive trauma restricts normal gliding and sliding of the tendons. This causes inflammation and further thickening within the sheath and not the tendons themselves.

What causes De Quervain’s Tenosynovitis?

Individuals that perform repetitive pinching tasks and grasping tasks are most susceptible to this condition. Examples include barbers that use scissors regularly and gardeners with shears. Mothers with newborns often suffer from this condition from the repetitive motion of holding the infant with the thumb in a prolonged extended position. However, with the evidence right now, the cause is not definitive and is based greatly on observational data.

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Figure 2: Repetitive usage example

How to diagnose De Quervain’s Tenosynovitis

Your health practitioner will first take the subjective history of your condition. A physical examination is followed by this to confirm the diagnosis. Should this not be clear enough, an Ultrasound scan can be organised with a 95% specificity 85% sensitivity in diagnosing De Quervain’s Tenosynovitis. The percentages basically means Ultrasound scans are effective in identifying De Quervain’s Tenosynovitis. Further scans such as MRI is even more effective in diagnosing, however often not required.

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Figure 3: Eichhoff’s maneuver – Physical examination example

Treatment Pathways

There are two most common pathways for De Quervain’s Tenosynovitis.These include conservative and surgical management.

Conservative management involves wearing a splint to allow the thumb and wrist to rest. A gentle stretch is often prescribed and strengthening once tolerable. Other factors such as changes to ergonomics are optimised on a case by case basis

If this does not settle the symptoms enough, a Cortisone Injection coupled with splinting is even more effective than splinting alone or injection alone over a 6 month period. The splinting timeframe is often discussed with the individual and would involve wearing it for 4 to 6 weeks first

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Figure 4 & 5: Splinting examples

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Should conservative treatment fail, surgical management is the next step. The surgery is a simple release of the thickened retinaculum tissue that covers the sheath of the tendons. Generally, this has a high success rate given the individual stays compliant with the post-op rehabilitation

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Figure 6: Released structure in surgery

References:

  1. Mak, J. (2019). De Quervain’s Tenosynovitis: Effective Diagnosis and Evidence-Based Treatment. IntechOpen. doi: 10.5772/intechopen.82029
  2. Ippolito JA, Hauser S, Patel J, Vosbikian M, Ahmed I. Nonsurgical treatment of DeQuervain tenosynovitis: A prospective randomized trial. Hand (N Y) 2018;1558944718791187. doi: 10.1177/1558944718791187.
  3. Stahl S, Vida D, Meisner C, et al. Systematic review and meta-analysis on the work related cause of De Quervain tenosynovitis: A critical appraisal of its recognition as an occupational disease. Plast Reconstr Surg 2013:132(6):1479–91. doi: 10.1097/01.prs.0000434409. 32594.1b.

Figure References:

  1. Figure 1: Tendons and Sheaths involved: https://cdnintech.com/
  2. Figure 2: Repetitive usage example: https://media.istockphoto.com/
  3. Figure 3: Eichhoff’s maneuver – Physical examination example: https://www.intechopen.com/
  4. Figure 4: Photo taken with consent
  5. Figure 5: Photo taken with consent
  6. Figure 6: Released structure in surgery: https://embed.widencdn.net/

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