De Quervain’s Tenosynovitis
The thumb is an integral part of the hand and is used in most activities involving the hand. As a result of this, the tendons that move the thumb are prone to overuse injuries and developing tendonitis (inflammation of a tendon). The thumb can move in many different directions, and there are many tendons that move the thumb.
De Quervain’s tenosynovitis is a condition where the tendons that extend the thumb become inflamed as they pass through a tunnel on the side of the wrist, resulting in pain. The tunnel is called the extensor retinaculum. Symptoms of De Quervain’s tenosynovitis are pain around the thumb side of the wrist which is exacerbated by movement, particularly opposing the thumb towards the little finger. There may also be a painful swelling at the bony part of the wrist where the thumb extensor tendons run through the extensor retinaculum. This condition is normally caused by overuse. It is also quite common in pregnancy and in women with new-born babies.
Usually, the tendons run through a single compartment in the tunnel. However, some people have slightly different anatomy where the tunnel is split into separate compartments. These separate compartments are quite small, and therefore people who have this anatomical variation are prone to developing De Quervain’s tenosynovitis. People who have this anatomic variation will often require surgery as the conservative treatment does not work as well.
Treatment is initially conservative with activity modification and a corticosteroid injection. Splinting can also help rest the thumb and may help. The majority of cases get better with conservative treatment. The few that don’t get better can be cured with a small operation to release the tendons. The operation can be done under local or general anaesthetic and is usually a day procedure. Results of surgery are excellent.