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Articles
De Quervain’s Disease of the wrist
De Quervain’s disease is a very common
inflammatory disorder of the wrist. A French Physician, De Quervain
in 1895, first identified this condition. He had seen several patients
experiencing pain, and discomfort on the thumb side of the wrist. He
noticed that most of these patients had one thing in common; they used
their hands in a repetitive, laborious fashion. This created symptoms
of pain, swelling and extreme discomfort in their thumbs, and wrists.
The condition he described is a 1st dorsal compartment tenosynovitis,
which is now commonly called De Quervain’s Disease.
DeQuervain’s tenosynovitis is a condition that is caused by repetitive
activities and motions, causing extreme and often disabling wrist pain.
This is commonly seen in golfers, grocery store checkers, new mothers,
computer operators, landscapers, data entry personnel, painters and
other highly repetitive occupations, sports, and hobbies. The condition
can also be caused by direct trauma, diabetes, rheumatoid arthritis,
thyroid conditions and pregnancy to name a few.
On the radial or thumb side of the wrist there are two tendons, the
abductor pollicis longus, and the extensor pollicis brevis, that control
thumb motions. These two tendons
are situated next to each other in a shallow groove along the radius
bone and covered by a roof of tissue called the extensor retinaculum.
This area is called the 1st dorsal compartment of the wrist. With excessive
deviation or lateral motions of the wrist, as well as movement of the
thumb, as in pinching, irritation and excessive pressure develops in
this region. This leads to an inflammatory response in the tendons,
or tendonitis. In some cases there may even be a thickening over the
radius bone, which appears as a slight “bump”, and causes
extreme tenderness. Women are more commonly likely to have this problem
and it is hypothesized that this may be due to the anatomic angulation
of the female wrist.
There are specific tests that can aid the Physician or therapist in
making a diagnosis of De Quervain’s. One test is called a Finkelstein’s
maneuver, which involves a specific positioning of the thumb and movement
of the wrist, which if pain occurs positive diagnoses is made. Other
tests include direct palpation of the tendons, resistance to thumb motion
etc.
Treatment of De Quervain’s disease can be approached in many different
ways. Initially, the offending activity must be stopped and the wrist
should be “rested” to allow a decrease in the inflammatory
response of the tendons and soft tissues. This can be accomplished by
use of a thumb spica splint that immobilizes the wrist and thumb. The
Physician may treat the condition with a non-steroidal anti-inflammatory
agent, and in unresponsive cases steroidal injections into the tendon
synovial sheaths may help. In severe cases, surgical decompression of
the 1st dorsal compartment may be needed to resolve pain.
Another option is Hand Rehabilitation carried out by Certified Hand
Therapist who specializes in treatment of disorders of the wrist and
hand. The therapist may fabricate a splint and initiate a therapy program
that reduces inflammation, mobilizes soft tissues, and gradually restores
pain free mobility, strength, and function back to the hand.
In summary, De Quervain’s can be very disabling and without medical
intervention that disrupts the inflammatory process, one can be left
with a chronically painful thumb and wrist.