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Berkshire
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London
Dequervains tenosynovitis
What?
Dequervains tendonitis/ tenosynovitis is a painful condition affecting the tendons on the thumb side of the wrist.
If you have de Quervain tenosynovitis, you will probably feel pain when you turn your wrist, grasp anything or make a fist.
Why?
Tendons run in 'canals' called tendon sheaths. Two of the tendons that move your thumb (abductor pollicis longus and extensor pollicis brevis) develops inflammation causing thickening of the sheath 'tunnel' where the tendons pass through located at the wrist.
Who?
The exact cause is unknown but new mothers are particularly prone to this condition, hence the term ' Mommies thumb' for this condition. Repeatedly lifting small babies with the thumb extended aggravates the pain.
How?
DIAGNOSIS:
The diagnosis is made by examining your hand. A classic test that reproduces pain is called the 'Finkelstein test', where the inflamed tendons are stretched. MRI scans have limited value.
TREATMENT:
The first line of treatment is activity modification (avoid tasks that aggravate symptoms) and use of a splint when doing manual tasks. In mild cases this may be all that is needed.
Splint: The splint should support both the thumb and wrist.
Generally the vast majority of patients referred to me require an Ultrasound guided Cortisone/ Steroid injection into the inflamed tendon sheath. In 70% of cases symptoms resolve, occasionally a second injection maybe considered.
The final resort of resistant symptoms is surgery. Surgical decompression of the tendon tunnel creates more room for the tendons to glide without catching.
Me?
Surgical decompression for Dequervains tenosynovitis is only considered when non-operative treatment has failed and your symptoms are affecting daily function.
Surgery has a reported rate of 95% success in improving symptoms.
Reported complication rates are 11%.
The main risk is damage to the superficial radial nerve branches which travels across the incision site. Other risks include tendon subluxation, painful/ hypertrophic scar.