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Update on Diagnosis and Treatment of de Quervain Tenosynovitis

Surgeons and medical students from Temple University in Philadelphia reviewed a condition called de Quervain disease. This painful wrist problem is also referred to as tenosynovitis or stenosing tendovaginitis.

The condition is recognized when patients report pain with gripping or grasping objects. The painful symptoms occur at the base of the thumb. The pain increases when raising objects while keeping the wrist in a neutral position. Moving the wrist away from the thumb side of the hand makes the symptoms worse.

Friction from repeated motions causes wear and tear on the soft tissues in the first dorsal compartment. There are six compartments or tunnels along the back of the wrist and hand. These tunnels are made up of fibrous connective tissue and bone. They provide a place for the tendons to slide and glide during motion of the wrist and hand.

With repeated use, the tendons and surrounding connective tissue starts to thicken. Sometimes the tissue becomes so dense, it is five times the normal size. There isn't so much of a problem with inflammation in de Quervain's as there is with degeneration of the tissue.

The condition is diagnosed based on symptoms and exam. The surgeon conducts several tests specific to de Quervain's. One of those tests is the Finkelstein test. The examiner grasps the patient's thumb and quickly moves the wrist and hand toward the little finger. Reproducing the pain with this motion is considered a positive test for de Quervain's.

Patients with arthritis may have a positive Finkelstein test, too. There are several other tests that may be better for diagnosing de Quervain's. One is the Eichoff maneuver. It is similar to Finkelstein’s. First, the patient's thumb is placed inside the fist. Then the patient bends the fist toward the little finger.

Treatment is reviewed starting with nonsurgical intervention. Rest, splinting, and antiinflammatory drugs or steroid injections are tried first. Specific details of each treatment modality are presented.

Surgery to release the tissue along the top of the dorsal compartment may be needed. This takes the pressure off the tendons. The surgeon must be careful to avoid cutting the radial sensory nerve located in the same area.

Surgery can be a challenge because the anatomy of the dorsal compartment is different from patient to patient. The authors provide a detailed step-by-step description of their preferred technique.

Results from surgical release of de Quervain disease are excellent. Complications may occur in a small number of patients. These include persistent pain, scarring, or neuritis. A second surgery may be needed to address these problems.

References: Asif Ilyas, MD, et al. de Quervain Tenosynovitis of the Wrist. In Journal of the American Academy of Orthopaedic Surgeons. December 2007. Vol. 15. No. 12. Pp. 757-764.

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