De Quervain's Tenosynovitis
Original Editor - Elizabeth Dallas, Boris Alexandra
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entry: de quervain's AND tenosynovitis AND physiotherapy
Clinically Relevant Anatomy
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De Quervain's tenosynovitis involves the abductor pollicis longus and the extensor pollicis brevis tendons.
A tendon is a fibrous cord that joins muscle to bone or muscle to muscle, made out of collagen.
m. extensor pollicis brevis (EPB) [2]
origin: ½ dorsal side of the radius, the membrana interossea
insertion: base of the proximal phalanx of the thumb
function: - wrist joint: radial abduction
- thumb: extension
innervations: N. radialis
artery: A. interossea posterior
m. abductor pollicis longus (APL) [2]
origin: dorsal side of the radius and the ulna, the membrana interossea
insertion: base of ossis metacarpi I
function: - wrist joint: radial abduction
- thumb: abduction
innervations: N. radialis
artery: A. interossea posterior
The retinaculum mm. extensorum is a strong, fibrous structure that holds all the wrist extensors into place. I’is located on the dorsal side of the wrist. [2]
Definition/Description[edit | edit source]
De Quervain’s tenosynovitis is an inflammation of the tendons of m. extensor pollicis brevis (EPB) and the m. abductor pollicis longus (APL). These muscles are located on the dorsal side of the forearm and go to the lateral side of the thumb through a fibrous-osseous tunnel made of the processus styloideus radii and the retinaculum mm. extensorum. [1] [2] [3]
Epidemiology /Etiology[edit | edit source]
It’s common in sports like golf, bowling, tennis, mountain bike and it includes mothers of young children, computer keyboards operators, engine drivers,… .
It’s caused by repetitive use of the thumb in combination with radial deviation of the wrist. (pinching, wringing, lifting, grasping, gardening, knitting). In this position the tendons of the EPB and the APL are pressed to the processus styloideus and when the movement is repeated frequently it can cause irritation of the tendons by friction. The tendons swell, the tunnel becomes too small. [1] [3] [4]
In the technology age is has been nicknamed “Blackberry Thumb”[1]
Clinical Presentation[edit | edit source]
DeQuervains occurs in women 8-10 times more often than men. [2]The condition can be sudden or gradual. Presents most commonly with pain, swelling and tenderness on the radial side of the wrist at the base of the thumb (first dorsal compartment) as well in rest as in radial deviating of the wrist. Abduction of the thumb is also painful. The pain can radiate into the forearm and distally into the thumb. [3] [4] Symptoms increase with pinching, grasping, and gripping activities. New mothers are prone to this due to child care tasks with lifting, holding and feeding placing the hand in awkward positions; as well as hormonal changes. [3]
Differential Diagnosis
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1. Osteoarthritis of the first CMC joint[1][4]
2. Intersection syndrome – pain will be more towards the middle of the back of the forearm and about 2-3 inches below the wrist[1][4]
3. Wartenberg’s Syndrome - isolated neuritis of the superficial radial nerve, can be caused by tight jewelry[1][4]
Diagnostic Procedures[edit | edit source]
Swelling, pain, tenderness on the radial side of the wrist.
Finkelstein-test : It’s a pain provocation test.
The patient has to make an thumb adduction or an clenched fist in combination with an ulnair deviation. The patient feels pain on the radial site of the wrist around the processus styloideus. [3] [4]
Examination[edit | edit source]
Finkelstein test
en.wikipedia.org/wiki/File:Originaler_Finkelstein-Test.jpg#file
Medical Management (current best evidence)[edit | edit source]
Surgery is indicated if conservative therapy doesn’t help to improve the symptoms and complains of the patient. It’s also indicated when the patient relapses. [3] [4]
Surgery:
The sheath of the first dorsal compartment is opened longitudinally for decompression.
Physical Therapy Management (current best evidence)[edit | edit source]
Non Operative:
Rest: activity modification and use of brace/splint for the thumb and wrist.
Anti-inflammatory: oral medication, phonophoresis, inotophoresis, or cold packs.
Injection: steroid
Key Research[edit | edit source]
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Resources
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Clinical Bottom Line[edit | edit source]
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Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
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- ↑ 1.0 1.1 1.2 1.3 Wikipedia. De Quervain syndrome. www.en.wikipedia.org/wiki/DeQuervain's_syndrome (accessed 13 Dec 2009)
- ↑ What is de Quervain's Disease? www.webmd.com/rheumatoid-arthritis/de-quervains-disease (accessed 15 Dec 2009)
- ↑ assh.org/Public/HandConditions/Pages/deQuervain'sTendonitis.aspx (accessed 13 Dec 2009)
- ↑ 4.0 4.1 4.2 DeQuervain's Disease - Wheeless' Textbook of Orthopaedics www.wheelssonline.com/ortho/dequervains_disease (accessed 13 Dec 2009)
