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De Quervains – Overview

January 21, 2021
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"De Quervain's tendonitis or tenosinovitis is inflammation involving a tendon at the radial or thumb side of the wrist. Because it can commonly be seen in parents who commonly stress the tendons while lifting their small child. It is also known as new mother's wrist, though it has been known to affect fathers, uncles, aunts, and grandparents, as well as pet owners. The condition is common in those who care for small children or pets, as well as laborers who may overuse or stress these tendons. A tendon is a tough, flexible structure made mostly out of collagen, which allows muscles to act on our bones and joints. Tendonitis as an overuse or strain condition, which causes inflammation within and around the tendon. In the case of de Quervain's syndrome, the tendons at the radial side of the wrist, an area which is known as the first dorsal compartment, become inflamed. These tendons pass from the forearm to the thumb. De Quervain's was named after a Swiss surgeon named Fritz De Quervain who also described many other conditions, including those affecting the thyroid. De Quervain's symptoms typically include pain and swelling at the radial side of the wrist, near where the thumb meets the wrist. The pain usually is worse with lifting, especially with the forearm in neutral rotation. Meaning with the palm facing the middle of the body. A small cyst can sometimes be present at the thumb side of the wrist in cases of De Quervain's. The presence of the cyst is usually not the reason for the pain. Rather it is just a sign of the disease. However, the cyst can be sensitive and may cause pain when bumped into other objects. A doctor or a therapist can be consulted in any case of suspected De Quervain's, and a treatment plan can be initiated. Other causes of wrist and thumb pain, such as trigger thumb, basal joint arthritis, scaphoid fracture, or another form of tendonitis called intersection syndrome, can also be ruled out. In most cases, DeQuervain's is due to either acute or repetitive chronic injury. The condition is commonly seen in new parents or pet owners. It can also be more common in patients with thyroid dysfunction, rheumatoid arthritis, diabetes, or gout. Anti-inflammatory medications, such as Neproxin, ibuprofen, Meloxicam or diclofenac may be used in treating DeQuervain's. These are often prescribed for a two to three week period to be taken every day so that they can over time work on gradually improving the inflammation. These medications can often be used for a few weeks to help combat the longstanding inflammation that is present. Though caution should be taken, especially in cases where the patient has a history of gastric ulcers or kidney disease, as NSAID medications can affect these systems. Patients who are on a blood thinner also must be careful when taking NSAID medications. Anybody with any potential interactions or problems should ask their own doctor prior to taking NSAID medications. A thumb spike, a brace which is a wrist brace that has an extension which mobilizes the thumb, can be very helpful in immobilizing and resting the painful tendons. Physical therapy or hand therapy is also commonly recommended. Ice and rest can be helpful as well. De Quervain's tendonitis can be treated at home, often successfully. Injections are sometimes used for treatment in cases that failed to respond to other measures. Surgery is not commonly needed for the treatment of De Quervain's since most cases resolve without it. Surgery is reserved for cases that fail to respond to non-surgical management, including injections. In surgery, the sheath over the affected tendons is released. And a second compartment known as a sub sheath, that lies within the first sheath, usually needs to be released as well. Surgery has a high success rate, but as with any procedure, there is a risk of complications. The one that we surgeons worry about the most in De Quervain's is injuring the delicate superficial branch of the radial nerve, which is a nerve that crosses directly in the path over this compartment and is at risk during surgical release of the first dorsal compartment. Thankfully it is not often injured, but if it is, it can cause long-term symptoms."

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