FAQs on De Quervain’s disease
De Quervain’s disease is the most reported tendon problem in the hand after trigger finger problem. Known by various popular names, such as gamer’s thumb and BlackBerry thumb, it is a type of entrapment tendinopathy that causes pain when you turn your wrist or grasp things. Mostly found in middle-aged people, it has a three-time more predilection toward females.
What is De Quervain’s disease?
De Quervain’s disease is a painful disorder associated with “inflammation and irritation in
tendons at the base of the thumb.”
The pain is felt on the radial side of the wrist where affected tendons that control the thumb movement “run through a tunnel on the thumb side.”
The syndrome is named after Fritz de Quervain, a Swiss surgeon, who described it in 1895. De Quervain’s disease is a form of tenosynovitis or inflammation of fluid-filled sheath that covers tendons with pain, swelling, and trouble in moving the inflamed joint.
Pain emanates as swollen tendons and sheaths rub against each other in the narrow tunnel on the thumb side of the wrist.
What are the symptoms of De Quervain’s disease?
- Pain or swelling on the back of the thumb close to the wrist
- Pain radiates to forearm
- Worsening pain with wrist and thumb movements
- Pain while grasping or making a fist
How does De Quervain’s disease occur? What are the structures affected by it?
De Quervain’s disease affects two rope-like tendons – abductor pollicis longus and extensor pollicis brevis. Running side by side through a tunnel on the thumb side of the wrist, each of them covered by synovial sheaths provides motion to the thumb. The sheath is a slippery layer allowing tendons to slide in the tunnel.
Repetitive stress, injury, degenerative process, and other medical conditions impact the cells in the sheath responsible for lubricating it. In the absence of lubrication, friction between tendons increases leading to inflammation, irritation, or swelling of the sheath. This causes abnormal thickening of the sheath. As you move your wrist or thumb, there is enhanced friction resulting in painful condition.
What are the causes of De Quervain’s disease?
- Injury to wrist/ thumb tendons due to overuse or repetitive stress
- Injury to the thumb due to direct blow or strain
- Rheumatoid arthritis causing inflammation in the wrist and thumb
- Activities, such as racquet sports, golf, gardening, piano-playing, or job profile calling for increased wrist bending or thumb use
- Scar tissue formation in the tunnel
Who are at the risk of De Quervain’s disease?
Women are more prone to De Quervain’s disease that mostly occurs in the 30-50 age group. Pregnant women and mothers of small babies are also at the enhanced risk. Tasks involving repeated wrist and thumb movements, diabetes, and rheumatoid arthritis also increase the risk of the tenosynovitis.
When to see a doctor?
Visit your doctor if the pain prolongs restricting thumb functions and there is no indication of healing despite medications, rest, ice therapy and change in activities.
How is De Quervain’s disease diagnosed?
The Finkelstein test, a type of physical examination, is the most used way to diagnose DeQuervain’s disease. The patient is told to place the thumb in his or her palm and make a fist. As the wrist bends to the side of the little finger, the thumb pulls the tendons in the tunnel. If there is pain during the procedure, the patient is diagnosed with De Quervain’s disease.
X-rays may be used to rule out fractures or ligament tears.
What are the treatment methods available for De Quervain’s disease?
- Self-care and Rest: Avoid stressful activities and use ice therapy regularly for a few days.
- Splints: Thumb-spica splints wrapped around the thumb and wrist keeps the joints in the area free from further stress and strain. This gives healing a chance to start.
- Medications: NSAIDs and other painkillers, both cream and pills, ease swelling and relieve pain.
- Corticosteroids Injection: Injected directly to the sheath area causing pain, corticosteroids lessen inflammation and pain. The treatment method is found to be effective in ensuring complete recovery from De Quervain’s disease within six months of taking one injection.
- Physical Therapy: Change in habits, wrist-specific exercises, and other procedures help limit tendon irritations, reinforce muscles, and ease pain in the thumb.
- Surgical Treatment: Surgery focuses on creating more space for tendons so that there is no friction between them. The tendon tunnel is widened by opening the sheath or splitting the roof.
Piver JD, Raney RB. De Quervain’s tendovaginitis. Am J Surg 1952 Mar;83(5):691–Kulthanan T, Chareonwat B. Variations in abductor pollicis longus and extensor pollicis brevis tendons in the Quervain syndrome: a surgical and anatomical study.
Scand J Plast Reconstr Surg Hand Surg. 2007;41(1):36-8.
Pagonis T, Ditsios K, Toli P, Givissis P, Christodoulou A. Improved corticosteroid treatment of recalcitrant de Quervain tenosynovitis with a novel 4-point injection technique. Am J Sports Med. Feb 2011;39(2):398-403
Arons MS. de Quervain’s release in working women: a report of failures, complications, and associated diagnoses. J Hand Surg [Am]. Jul 1987;12(4):540-4
Otto N, Wehbé MA. Steroid injections for tenosynovitis in the hand. Orthop Rev 1986; 15:290.
Huisstede BM, Coert JH, Fridén J, Hoogvliet P. Consensus on a Multidisciplinary Treatment Guideline for de Quervain Disease: Results From the European HANDGUIDE Study. Phys Ther. Aug 2014;94(8):1095-110.
Anderson BC, Manthey R, Brouns MC. Treatment of De Quervain’s tenosynovitis with corticosteroids. A prospective study of the response to local injection. Arthritis Rheum 1991; 34:793.
Weiss AP, Akelman E, Tabatabai M. Treatment of de Quervain’s disease. J Hand Surg [Am]. Jul 1994;19(4):595-8.
Ta KT, Eidelman D, Thomson JG. Patient satisfaction and outcomes of surgery for de Quervain’s tenosynovitis. J Hand Surg Am 1999; 24:1071.
Coldham, F (2006). “The use of splinting in the non-surgical treatment of De Quervains disease: a review of the literature”. British Journal of Hand Therapy 11 (2): 48–55.