 What
is it?
This condition consists of a tenosynovitis of the first dorsal
compartment. Within this compartment at the wrist is contained
the extensor pollicis brevis (EPB) and abductor pollicis longus
(APL) tendons. It is manifested by pain at the base of the
thumb that migrates up the wrist and forearm. It gets worse
with thumb movement or grip. It is especially bothersome when
trying to open large-mouth jars such as pickles. The pain is
crescendo in nature often precluding the ability to continue
to hold the object.
Cause
It is felt that this syndrome occurs from overuse combined
with a sub-acute injury to the wrist. It can be seen in the
terminal stages of pregnancy and post-partum. Patients with
fluid retention disorders can present with de Quervain’s
Tenosynovitis.
Diagnosis
The history and physical exam is crucial in making this diagnosis
as several other conditions may mimic this syndrome. The history
is usually one of chronically increasing pain at the wrist
that migrates into the thumb and forearm. On exam, localized
tenderness will be palpable over the wrist where the tendons
cross under the extensor retinaculaum into their tunnel. There
are 6 tunnels on the backside of the wrist (dorsal). The tunnel
involved will be the first dorsal compartment. A sensitive
test is the Finklestein Test in which the fingers grip the
thumb, and then the whole wrist is ulnar deviated (pushed toward
the little finger). Pain on resisted thumb extension or abduction
can also be seen. X-rays are usually not indicated.
Treatment
Conservative treatment is usually begun with splinting the
wrist and thumb. (Please note; a carpal tunnel splint does
NOT adequately immobilize the thumb)
Non-steroidal anti-inflammatory drugs (NSAID’s) are
utilized to reduce the inflammation. On occasion, your Orthopedic
Surgeon may inject a steroid solution into the first dorsal
compartment. If symptoms persist your surgeon may recommend
a surgical procedure. In this 10-minute procedure, the roof
of the tunnel is released, allowing the tendons to glide freely.
A splint is applied that allows movement at the tip of the
thumb to keep the tendons gliding. Usually the patient returns
to full activities at two weeks post-operatively.
Trivia
Fritz de Quervain first described this syndrome in 1895. He
was a distinguished general surgeon who was Professor of Surgery
at Berne, Switzerland. He was born at Sion in the Valais Canton
of Switzerland, where his dad was the pastor. After his surgical
training he settled in the watch-making district of La Chaux-de-Fonds.
He worked extensively on Thyroid Goiter and is responsible
for the introduction of iodized table salt to help prevent
goiter. Initially this tenosynovitis syndrome was thought due
to tuberculosis.
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