The extensor tendons of the wrist and fingers at the level of the wrist run through discrete tendon sheaths, called extensor compartments. De Quervain's tendovaginitis (tenosynovitis) is an inflammation of the tendons, which run along the wrist at the side of the thumb in the first extensor tendon compartment and extend the thumb.
The most common cause of inflammation is overexertion of the tendons. Trauma, especially contusions at the side of the first extensor compartment, can also result in inflammation.
The primary symptom is pain on the lateral side of the wrist (the side of the thumb) with radiation into the thumb and forearm. The pain is aggravated by specific thumb or wrist movements. In particular, maneuvers that involve full thumb flexion and a firm grip, can cause pain (e.g. turning the key to start the car, operating the handle of a door). With severe inflammation, the pain appears even at rest and swelling of the lateral wrist may occur. Sometimes movement of the thumb is accompanied by a snapping or clicking sound, which is a consequence of peritendinous inflammation and edema.
The diagnosis of De Quervain's Tenosynovitis is primarily clinical, based on history and physical findings. Additional ultrasound examination can confirm the diagnosis. To rule out other causes for pain in this localization, such as arthritis or a fracture, an X-ray can be performed.
The goal of treatment is to alleviate inflammation and pain. At first, we attempt healing by means of a two to three-week immobilization of the wrist and thumb accompanied by anti-inflammatory medication. Where required, assisted by supportive hand therapy. If this doesn`t lead to success, a local injection of a mixture of cortisone and local anesthetic can be performed.
If conservative therapy options fail to improve the condition, surgery is indicated. The procedure consists of opening and expanding the first extensor tendon compartment, which surrounds the tendons. This provides additional space for the tendons and allows the inflammation to subside.
Follow up care
At the end of the operation a bandage is applied, which is left in place until the first wound check two or three days later. Afterwards, depending on the degree of discomfort, an elastic lightly supportive dressing can be worn. Otherwise the wound can be covered with band-aid. It takes usually about four weeks until return to full function.